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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001a. letter
From: Hillary Rodham Clinton, To: Mr. & Mrs. Markson (1 page)
4/18/94
b(6)
001b. letter
From: Hillary Rodham Clinton, To: Mr. & Mrs. Markson (1 page)
2/17/94
b(6)
001c. letter
From: The Markson Family, To: Mrs. Rodham Clinton (6 pages)
2/4/94
b(6)
002. memo
From: Jennifer Klein, To: Hillary Rodham Clinton, Re: Telephone
2/18/94
b(7)(E)
Calls [partial] (1 page)
003a. letter
From: Policyholder to: Lynn Gruber [partial] (1 page)
4/6/94
b(6)
003b. letter
From: Policyholder, To: Lynn Gruber [partial] (1 page)
4/7/94
b(6)
003c. letter
From: Policyholder, To: Commissioner Ullaud [partial] (1 page)
4/11/94
b(6)
003d. letter
From: Policyholder, To: Those considering premium increases
3/26/94
b(6)
[partial] (2 pages)
003e. letter
From: Policyholder, To: Minnesota Comprehensive Health
4/4/94
b(6)
Association [partial] (1 page)
003f. letter
From: Policyholder, To: Commissioner Ullaud [partial] (1 page)
3/7/94
b(6)
003g. letter
From: Policyholder, To: Gentlemen [partial] (1 page)
3/31/94
b(6)
003h. letter
From: Policyholder, To: Ms. Gruber [partial] (1 page)
3/28/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)|
P1 National Security Classified Information |(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003i. letter
From: Policyholder, To: Mr. Gruber [partial] (1 page)
3/20/94
b(6)
003j. letter
From: Policyholder, To: Lynn Gruber [partial] (2 pages)
3/22/94
b(6)
003k. letter
From: Policyholder [partial] (1 page)
3/21/94
b(6)
0031. letter
From: Policyholder, To: Lynn B. Gruber [partial] (1 page)
3/28/94
b(6)
003m. letter
From: Policyholder, To: Lynn Gruber [partial] (1 page)
nd
b(6)
003n. letter
From: Policyholder, To: Mrs. Lynn Gruber [partial] (2 pages)
3/26/94
b(6)
003o. letter
From: Policyholder, To: Sir or Madam [partial] (1 page)
3/9/94
b(6)
003p. letter
From: Policyholder, To: Sir/Madam [partial] (1 page)
3/7/94
b(6)
003q. letter
From: Policyholder [partial] (1 page)
nd
b(6)
003r. letter
From: Policyholder, To: Lynn [partial] (1 page)
3/23/94
b(6)
003s. letter
From: Policyholder, To: Mr. Gruber [partial] (1 page)
nd
b(6)
003t. letter
From: Policyholder, To: MCHA Board of Directors [partial] (1 page)
3/6/94
b(6)
003u. letter
From: Policyholder, To: Board of Directors [partial] (1 page)
3/17/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
004. resume
George D. Monardo, Personal Data [partial] (1 page)
nd
b(6)
005a. letter
From: Hillary Rodham Clinton, To: Ms. Mary Musk (1 page)
10/28/94
b(6)
005b. letter
From: Mary Musk, To: Hillary Clinton (3 pages)
10/6/94
b(6)
005c. memo
From: Karen Guss, To: File, Re: letter from Mary Musk (2 pages)
11/21/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency |(b)(2) of the FOIA|
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
h(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
HRC
HC CORR 94-M
PERSONAL
&
CONFIDENTIAL
DETERMINED TO BE AN
ADMINISTRATIVE MARKING
INITIALS: ADB DATE: 12-4-13
PHOTOCOPY
PRESERVATION
CHARANT officer
I
A.R.
MACLED
USCG N.Y. Governors Island
Heath Care ReForm
PHOTOCOPY
HRC HANDWRITING
Belmed B udget
To Jenny blem-
can you write am
corp, WILLINS
OT
Marathon
House
PHOTOCOPY
PRESERVATION
Adult Services Division
Marathon, Inc.
Box 319
HC CORR
THE WHITE HOUSE
WASHINGTON
September 20, 1994
Warrant Officer A.R. MacLeod
United States Coast Guard
Governor's Island, New York
Dear Warrant Officer MacLeod:
The First Lady asked me to contact
you. She would very much like to hear
your comments and suggestions about health
care reform and a balanced budget.
I look forward to hearing from you
and can be reached at the following
address:
Second Floor, West Wing
Office of the First Lady
The White House
Washington, D.C. 20500
Sincerely yours,
fennifer Klem
Jennifer Klein
Senior Policy Analyst
U.S. Department
Commander (k)
Governors Island
of Transportation
Maintenance & Logistics Command
Bldg 400, Section K.
Atlantic
New York, NY 10004-5080
Phone: (212) 668-7413
United States
Coast Guard
4200
NOV 28 1994
Ms. Karen Guss
Office of the First Lady
Old Executive Office Building
Room 212
Seventeenth Street and Pennsylvania Avenue
Washington, DC 20500
Dear Ms. Guss,
As you requested in our recent phone conversation, I am enclosing
a status report on our ongoing pilot projects to provide health
care for Coast Guard active duty dependents. These projects are
very limited in scope and selected to meet very specific
criteria. Because the populations are so small and the time
frame so short, I can not draw any conclusions with confidence
from the data obtained so far. In such small transient
populations, it may take many years to separate a valid trend
from extreme year to year fluctuations.
We have more experience with providing care for our active duty
population. The key to our success has been a cadre of
knowledgeable Coast Guard health care personnel taking personal
interest in getting an appropriate level of care at a reasonable
cost for our patients. They have had some success in reducing
costs by preventing unnecessary procedures, negotiating for more
reasonable costs, and directing care to preferred providers or
military treatment facilities.
I appreciate your interest in our programs. If I can be of
further service please let me know.
Sincerely,
W. B. LACKEY
Captain,
U. S. Public Health Service
By direction of the Commander
Encl: (1) Pilot Project Status Report
U.S. Department
Commander
Governors Island
of Transportation
Maintenance & Logistics
New York, NY 10004-5098
Command, Atlantic
Staff Symbol: k
Phone: (212) 668-7413
United States
Coast Guard
4200
NOV 28 1994
From: Commander, Maintenance & Logistics Command Atlantic
To:
Commandant (G-KOM)
Subj: DEPENDENT HEALTH CARE PILOT PROJECT
Ref: (a) COMDT (G-K) ltr 4200 of 8 May 91
1. As outlined in reference (a), the Omnibus Act of 1990
authorized the Coast Guard to provide outpatient primary health
care for dependents of active duty members by contracting with
non-federal practitioners and providers. We undertook a limited
number of pilot projects on a test basis aimed at providing
comparable level of care at a lower cost or enhanced level of
care at no increase in cost. Factors we considered in
establishing a Dependent Health Care Pilot Project (DHCPP) were:
a. "remote" sites with geographic barriers;
b. sites where medical treatment was not readily available;
C. sites where area providers did not accept CHAMPUS;
d. and sites where the costs of the medical treatment and/or
provider services were considered "excessive."
2. After evaluating thirteen potential sites from Maine to
Texas, we finally established a DHCPP at Chincoteague, Virginia
(May 1992), at Owensboro, Kentucky (October 1992) and at Grand
Isle, Louisiana (February 1993). These sites had an average
beneficiary population of 181, 31, and 69 respectively.
3. In Chincoteague we learned that although the command
requested a provider on the island, the patients preferred
providers nearer their homes. Through data obtained from
pharmacy invoices, we found that dependents generally tended to
use their preferred non-contracted provider instead of our
contracted (on-island) provider. Lack of access to health care
providers who accepted CHAMPUS appeared to be less a problem than
we initially thought. This contributed to our decision to
discontinue the DHCPP at Chincoteague on 1 October 1994.
4. In Owensboro, the DHCPP is still active. While many
providers were available there when we inaugurated the project,
none in the immediate area accepted CHAMPUS. In FY93, the
contract provider for our active duty population agreed to
provide primary care in support of DHCPP at fees less than or
equal to the CHAMPUS Maximum Allowable Charge (CMAC). However,
this DHCPP agreement and active duty contract were subsequently
terminated with this provider at the end of FY94 because of
patient dissatisfaction and the provider's noncompliance with
several contract stipulations. Beginning in FY95, the DHCPP was
Encl (1)
4200
NOV 28 1994
Subj: DEPENDENT HEALTH CARE PILOT PROJECT
reestablished with a hospital-based health care provider network.
This arrangement permits dependents a choice of providers, and
preliminary results indicate this arrangement is working well.
5. In Grand Isle, the DHCPP also continues. At the beginning of
this project there was only one provider occasionally available
two days per week, with the nearest medical facility to Grand
Isle over one hour's transit time away. As part of this DHCPP we
negotiated an agreement with the nearest medical facility to
locate contracted providers at various sites convenient to Grand
Isle beneficiaries. The providers agreed to render primary care
in support of DHCPP at fees less than or equal to the CMAC. This
long-term plan effectively provides a full-time contracted
provider presence on Grand Isle. This was in addition to a part-
time provider who also agreed to participate in the DHCPP.
6. The DHCPP data base is small and subject to anomalies and
spikes, as for example, singularly high cost medical treatments.
Comparative analysis has been hampered by still maturing data
bases and software. For example, CHAMPUS pharmacy costs were
unavailable to us, as was CHAMPUS information on individuals,
providers, and individual treatment plans. The data must be
approached cautiously, understanding that it serves more to
stimulate further analysis than to suggest results or trends.
Preliminary data is summarized in enclosure (1) and seems to
indicate some cost savings.
7. We can not with certainty pinpoint the reasons for the
apparent cost savings. They may be solely due to anomalies in a
very small data base, the vagaries of a small population or the
lag time from delivery of services to bill submission leading to
incomplete FY 93 costs. A few possible causes are:
a. Improved accessibility to an identified primary care
provider ("Gatekeeper") may have contributed to a reduction in
ancillary visits and related costs.
b. Reduced outpatient visit costs to the patient may have
lead to early intervention and detection of illnesses and
conditions before they required more expensive emergency or long
term treatment regimes.
C. Inability to pay up-front for medical care (as required
by some providers) coupled with having to wait for CHAMPUS
reimbursement may have previously lead patients to delay health
care visits.
2
4200
NOV 28 I994
Subj: DEPENDENT HEALTH CARE PILOT PROJECT
8. Customer satisfaction with DHCPP has remained high
attributable to such factors as improved accessibility to care,
minimal paperwork (claim filing), and reduction of overall out-
of-pocket expenses.
9. Additional lessons are being learned from DHCPP experiences:
a. Compiling and analyzing appropriate data is extremely
labor intensive at this time especially considering the small
populations involved. Better access and improved accountability
of data in computerized media is essential for long-term
enhancements.
b. Multiple variables among the existing data can easily
skew the data, e.g., high cost procedures, ever-changing
demographics of dependent populations caused by end-of-tour
rotations of active duty sponsors, trust or confidence in the
provider, and location of the primary care.
C. We have also learned that DHCPP needs to provide
dependents incentives to use "our" contracted provider or
disincentives to use non preferred providers.
10. Three potential DHCPP sites (Sault Ste Marie, Michigan;
Brunswick, Georgia; and Southwest Harbor, Maine) have been
evaluated by my staff. Of these, only Brunswick, Georgia appears
likely to meet our criteria for the establishment of a project.
11. My point of contact regarding this project is CDR James
Lachowicz, at (212) 668-7816.
W. By B. direction LACKEY
Encl: (1) MLCLANT Pilot Project Data
Copy: CG MLCPAC(k)
3
MLCLANT PILOT PROJECT DATA
Grand Isle
Out Patient and Ancillary Services
FY-91
FY-92
FY-93
CHAMPUS costs
$17,706
$38,186
$11,146
DHCPP costs
$0
$0
$1,787
Total Government Costs
$17,706
$38,186
$12,933
Pharmacy
FY-91
FY-92
FY-93
DHCPP costs
$0
$0
$2,145
NOTE: CHAMPUS pharmacy costs were not available through the KRIS
data system.
Out Patient Visits
FY-91
FY-92
FY-93
CHAMPUS
115
180
99
DHCPP
0
0
42
Total Visits
115
180
141
Ancillary Service Episodes
FY-91
FY-92
FY-93
CHAMPUS
219
368
239
DHCPP
0
0
7
Total Episodes
219
368
246
Sponsor Costs
FY-91
FY-92
FY-93
CHAMPUS
$6,748
$7,247
$3,991
DHCPP
$0
$0
$370
Total Sponsor Costs
$6,748
$7,247
$4,461
ENCLOSURE (1)
1
MLCLANT PILOT PROJECT DATA
Owensboro
Out Patient and Ancillary Services
FY-91
FY-92
FY-93
CHAMPUS costs
$16,999
$14,610
$4,532
DHCPP costs
$0
$0
$2,503
Total Government Costs
$16,999
$14,610
$7,035
Pharmacy
FY-91
FY-92
FY-93
DHCPP costs
$0
$0
$2,262
NOTE: CHAMPUS pharmacy costs were not available through the KRIS
data system.
Out Patient Visits
FY-91
FY-92
FY-93
CHAMPUS
70
78
23
DHCPP
0
0
48
Total Visits
70
78
71
Ancillary Service Episodes
FY-91
FY-92
FY-93
CHAMPUS
213
195
103
DHCPP
0
0
25
Total Episodes
213
195
128
Sponsor Costs
FY-91
FY-92
FY-93
CHAMPUS
$4,811
$4,785
$3,254
DHCPP
0
0
$470
Total Sponsor Costs
$4,811
$4,785
$4,040
2
MLCLANT PILOT PROJECT DATA
Chincoteague
Out Patient and Ancillary Services
FY-91
FY-92
FY-93
DHCPP costs
$0
$2,139
$5,595
Pharmacy
FY-91
FY-92
FY-93
DHCPP costs
$0
$4,935
$22,130
Out Patient Visits
FY-91
FY-92
FY-93
DHCPP
0
64
244
Sponsor Costs
FY-91
FY-92
FY-93
DHCPP
$0
$640
$2,350
NOTE: CHAMPUS Data was not available through the KRIS data
system for Chincoteague Island area.
3
Memorandum To:
President Clinton
Hillary Rodham Clinton
From:
Ira C. Magaziner
Subject:
Next Steps on Health Reform
Date:
8/21/94
The latest " rump group proposal is less comprehensive than the Senate Finance Committee bill,
and accomplishes less than the plan offered by former President Bush during his last year in office.
Saturday's Washington Post said accurately that " in its scope and financing, the plan is closer
to the minimalist health care plan sponsored by Dole than it is to Mitchell's scaled-back version of
Clinton's plan." Core democratic constituencies such as Labor, Seniors, progressive health care
providers and consumer groups will oppose the plan vehemently." The moderate Republicans
have "moved the bar" away from us again.
As we have suspected, there is not the will in the Senate to raise the funds necessary to achieve
anywhere near 95% coverage. The Mitchell bill contains a number of funding sources --the high
cost plan assessment, the removal of tax deductibility for health care in cafeteria plans and the risk
adjustment assessment on large companies-- which were bound to be unpopular. The rump
group removes them. They go further, and remove the assessment for academic health and
research and do not integrate Medicaid into the private sector, further reducing available funds.
To compensate for these losses, the rump group proposes a tax cap, reduces long-term care
spending by 80% from the already reduced levels in the Mitchell bill, eliminates the Medicare drug
benefit and the research and academic health initiatives and guts the public health initiatives. They
also set a goal of reducing the deficit by $100 billion over ten years from health reform. Though
no coverage estimates are yet available, it is likely that their proposal will fall well short of 95%
coverage.
As with the Mitchell bill, the sustainability of the " rump group's " financing is highly questionable.
Tax caps are even less likely to pass the Senate than premium caps. Sustaining over $240 billion
in Medicare cuts with no drug benefit, virtually no long-term care program and only marginal
increases in coverage may be very difficult.
Other troublesome aspects of the bill are provisions which encourge companies potentially to
drop coverage. Requiring companies who cover some full time employees to cover all full time
employees in a voluntary world may simply encourage some companies to drop all coverage. This
is especially true, when combined with another provision which makes the purchase of insurance
deductible to the individual.
The rump group proposal contains only a soft trigger to some Congressional review by 2002 if
95% coverage is not reached and when the tax cap is removed, it has no cost containment. Those
who thought that one could give up on all forms of premium caps and employer mandates and still
produce a comprehensive bill are now learning otherwise.
These latest developments, in my opinion, leave us with three choices:
1
If Mitchell can work something out with the rump group that Labor, seniors and other
health care reform supporters can stomach, we can hope for a stronger bill in the House
and go to conference.
2
We can fight for a strengthened Mitchell bill, either go to a vote and lose with perhaps 40+
votes or not go to a vote and urge Congress to go home, vowing to fight for universal
coverage next year.
3
We can propose our own minimalist alternative which makes more sense than those on the
table either through a summit or as a leadership substitute, try to pass it, and then vow
to fight for universal coverage next year.
A Mitchell-Rump Group Compromise
If we believe that the House can pass a substantially stronger bill than the Senate and that a
reasonable agreement can be reached between Senator Mitchell and the # rump group, then this
approach could make sense. There would be a health care bill this year. It would accomplish some
positive goals. We could avoid total defeat.
On the downside, the passage of this bill over what would likely be the objection of most
Republicans, would leave us vulnerable in a number of respects. Because it is a minimalist bill, it
will leave in place most of the causes for popular discontent with today's health care system. The
poor would get some subsidies to buy insurance, it would be harder for insurers to discriminate
against those with pre-existing conditions. But, people would still be denied coverage; their
benefits would still be cut back; costs would continue to rise; treatments would continue to be
denied to consumers by managed care companies saving money at consumer's expense; hospitals
in inner cities and rural areas wouldclose; Medicare and Medicaid cuts in the absence of universal
coverage would mean more doctors offices and hospitals might drop coverage for these
populations; Medicare premiums would rise for some; etc. Now, there would be a risk that all of
these occurrences would be blamed on the Clinton health plan instead of on the status quo health
system.
In addition, it is unlikely that either the public or the media would view this bill as a success for
the president. We could end up with the worst of both worlds; a political defeat and blame for a
health bill that doesn't work. We have always known that once a health bill passes, all ills of the
system would be blamed on it. With this minimalist bill, there may not be enough positives nor the
correction of enough of today's negatives to win that battle.
No Bill
The Republicans are trying to block any bill from passing and are perceived in many circles as
obstructionists. If the public perceives that the President is fighting for principles he and they
believe in, that he has been willing to compromise but is being blocked by Republicans who for
political purposes are trying to kill health reform (all of which is true), the Republican strategy
might backfire on them.
Urging Congress to go home and telling the public that the President would try again next year
could avoid our having to accept a bill which later is perceived by the public as a " lemon." It also
puts the onus on the other side and leaves us fighting for our principles. We are perilously close to
the line now on whether the bill proposed does more harm than good, so this is not a case of
allowing the perfect to be the enemy of the good.
If we cannot get good reform from the next Congress, then we can continue to fight for it into the
next term. The problems with the health care system will only get worse. The public will want
something done. If we continue to fight for our principles rather than accept something which
does not fix the problems and be saddled with its failure, we may produce more for the American
people in the long run.
This option also has many potential downsides. The next Congress may not do health reform and
might take Medicare and Medicaid savings only for the deficit, making health reform that much
more difficult. Democrats could be blamed severely at the polls this year and the President in 1996
for having failed to pass any health bill. The recriminations against the President, the First Lady,
the health care team and the Administration in general could be devastating.
An Administration Minimalist Approach
If we must accept a minimalist approach, and having some bill is better than having no bill, we
could try to put an alternative on the table which will do as much good and as little harm as
possible. While this would require broader discussion, a proposal like the following might have
merit:
1
Use Medicare, Medicaid integration and tobacco tax funds as proposed in the Mitchell bill
and eliminate from it all other sources of funding which essentially as those with good
insurance today.
2
Fund coverage for all children and pregnant women and for all people who have insurance
but lose their jobs for six months (with subsidies adjusted for income)
3
Fund a scaled back Medicare drug benefit and a scaled back long-term care initiative.
4
Provide $100 billion in deficit reduction over the ten year period.
5
Carry out the various insurance and market reforms described in the Mitchell bill as
amended by the rump group," with an eye toward disrupting the current market as little
as possible.
6
Try to maintain the Mitchell bill trigger with some type of cost containment commission
which makes recommendations on slowing the growth of costs if certain specified targets
are not met.
7
If Medicare cuts cannot be sustained, then cut the drug benefit. If the Mitchell trigger
cannot be sustained, there is still worth to the program.
We cannot claim victory with this type of proposal, but it is a responsible one which will allow us
to claim correctly that we are helping people with health insurance problems and that we are using
health reform to help fight the deficit into the next decade.
The downside to this approach is that the President will still be open to attack for failing to
achieve his goals and accepting less than universal coverage. He also will still be open to blame
for problems people have with the health care system. Since this will be more closely identified as
an administration position if we suggest it, we will have a harder time distancing ourselves from it
later on.
This option may also be moot. Congress may not want to take our suggestions.
DRAFT
8/21/94
Possible Options
1.
Mitchell accommodates enough of the mainstream to gain broader support of
Mitchell, as revised, with the balance of mainstream proposals being debated and
voted on.
-
How critical is the triggered mandate in Mitchell? If it is
supplanted by the 95% goal of the mainstream, and if the rest of
Mitchell revised works, can it be argued that it puts the country
on the path to universal coverage and, if so, should the
President support it?
The definition of "what works" is critical. If the President
cannot support Mitchell revised, should he declare an impasse;
that the Republicans are unwilling to support health care reform
this year; but that he will fight for health care reform next year.
If, after recess, the Congress enacts health care legislation, the
President can then decide whether to sign it or not.
-
It is likely, however, that many of the leadership groups
supporting health reform will walk away from Mitchell revised.
-
Even if the President wants to declare an "impasse" and to ask
the Senate to adjourn, Senator Mitchell may resist this course.
-
If Mitchell revised cannot be supported by the President, should
he demand a vote on the Mitchell triggered mandate as well as
on the key provisions to show the country who is blocking
health reform?
-
Even if Mitchell revised, without the Mitchell mandate, should
be pushed, what effect will it have on the House? This will
depend upon the configuration of Mitchell revised.
2.
If Mitchell cannot accommodate Chafee:
A.
Carry on with the debate on Mitchell and force an early vote on the
Mitchell mandate.
Options-Mitchell
8/21/94
-
If the vote retains the Mitchell mandate, it is unclear where the
process then goes.
-
If the vote defeats the Mitchell mandate, the President can
declare an "impasse"; state that the Republicans blocked health
reform; ask the Senate to recess; and state he will fight for
health reform next year.
B.
Mitchell tells the President that he needs a recess to work out a
modified bill (thus effectively telling the President there isn't sufficient
support in the Senate to enact the pending bill); the Senate goes on
recess; the press declares health reform dead this session; during the
recess, the President and at least the Democratic leadership devise a bill
that can be characterized as putting the country on the path to universal
coverage, along the lines of the congressional resolution (or some other
workable minimal approach) described in paragraph numbered 2 below.
-
The President could say that while the universal coverage as he
has worked for so hard can't be achieved this year, this
alternative proposal, which he devised with the Congress, is a
giant step toward that goal.
-
Although the public would likely support such a proposal, the
leadership groups favoring health reform may disown it.
C.
Mitchell tells the President that he cannot get his bill through the
Senate. The President declares an "impasse"; states that he has done
everything possible to achieve universal coverage, but the Republicans
block it; call a Democratic leadership summit (perhaps including some
Republicans) to work out an alternative that can command the necessary
votes in both chambers, but which will not include universal coverage.
Even under this option, the President may need a vote on the
Mitchell mandate before declaring an impasse and calling the
leadership summit to show he went the distance in trying to
achieve universal coverage.
This is a very risky strategy because it is highly probable that
the process will drag out, no agreement will be reached that can
2
1
Options-Mitchell
8/21/94
command sufficient support, and the President will merely
become bogged down in the process.
Other issues:
1.
The clock: If Mitchell cannot reach an accommodation with the mainstream, at least
in principle, this week, he may well not be able to hold the Senate in session after the
final vote on the crime bill. If so, the Senate is not scheduled to return until 12
(Monday) September at the earliest and perhaps not until 19 September.
The House is scheduled to return on 8 September (Thursday), but if the Senate has
not acted on health reform, it is unlikely that the House begin considering health
reform before the Senate has acted.
Even if the House begins debate before the Senate acts, will enough time remain to
enact health care this year?
2.
If Mitchell is unable to accommodate Chafee, is there any proposal that is less than
Mitchell that would be acceptable both politically and policy wise?
For example a congressional resolution (a) declaring a national goal to
achieve universal coverage by a date certain; (b) appointing a bipartisan
commission to make recommendations to the next session of Congress to
achieve that goal; (c) enacting critical insurance reforms dealing with
portability, pre-existing conditions, life time limits, rate bands, medical
underwriting (increasing rates), etc; (d) providing coverage for children,
pregnant women, and selected others to the extent funds are available; (e)
providing prescription drugs and the beginning of long term care for seniors;
and (f) some deficit reduction (whether all of (d),(e) and (f) can be financed
may be questionable).
3
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DOCUMENT NO.
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From: Hillary Rodham Clinton, To: Mr. & Mrs. Markson (1 page)
4/18/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
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an agency [(b)(2) of the FOIA)
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
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P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Jennifer will do more
lets want l annad to reply can
that w persont-er pince at Ram M get on my amount
PHOTOCOPY
HRC HANDWRITING
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DOCUMENT NO.
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From: Hillary Rodham Clinton, To: Mr. & Mrs. Markson (1 page)
2/17/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
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Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)|
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b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
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financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
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and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
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DOCUMENT NO.
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From: The Markson Family, To: Mrs. Rodham Clinton (6 pages)
2/4/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
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RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)|
P1 National Security Classified Information |(a)(1) of the PRA|
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA|
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
THE WHITE HOUSE
March 2, 1994
Mr. S. Hubert Mayes, Jr.
Mitchell, Williams, Selig,
Gates & Woodyard
320 West Capitol Avenue
Suite 1000
Little Rock, Arkansas 72201-3525
Dear Hubie:
Thank you for your letter and
clarification of Mr. Taylor's testimony
before the House Subcommittee on Commerce.
I have a bit of experience myself with
being misrepresented and misquoted so you
have my understanding!
I appreciate hearing from you and
thanks for your support.
With kind regards, I remain
Sincerely yours,
Hillary Itillary Rodham Clinton
do R
to: Melanne
aike
LAW OFFICES
LANCE R. MILLER
H. MAURICE MITCHELL
WYLIE D. CAVIN 01
RICHARD A. WILLIAMS. P.A.
MITCHELL. WILLIAMS, SELIG. GATES & WOODYARD
ERNEST G. LAWRENCE
JOHN $ SELIG
RICHARD L. ANGEL
JOSEPH W GELZINE
A PROFESSIONAL LIMITED COMPANY
EVERETTE L MARTIN
W. CHRISTOPHER BARRIER
JEFFREY H. THOMAS
BYRON FREELAND
ALLAN GATES*
320 WEST CAPITOL AVENUE. SUITE 1000
STUART P. MILLER
LITTLE Rock. ARKANSAS 72201-3525
DONALD L PARKER II
WILLIAM H. L. WOODYARD. 111. P.A
CHRISTOPHER T ROGERS
JOHN C. LESSEL
TELEPHONE 501-688-8800
AMELIA MOSLEY RUSSELL
DOAK FOSTER
TELEFAX 501-688-8807
RHONDA M. WHEELER
JEAN D. STOCKBURGER
MARSHALL S. NEY
ANNE RITCHEY
MARSHA FOSTER
EDWIN F. JACKSON
TINA EUBANKS MCKELVY
SHERRY P. BARTLEY
1420 NEW YORK AVENUE. N.W.. SUITE 750
130 WEST CENTRAL AVENUE
J. LEE COVINGTON II
CRAIG WESTBROOK
R T BEARD. III
WASHINGTON. D.C. 20005-2122
POST OFFICE Box 658
MARCELLA J. TAYLOR
TELEPHONE 202-347-4500
BENTONVILLE. ARKANSAS 72712-0658
COUNSEL
ARK MONROE. 111*
TELEFAX 202-347-7500
TELEPHONE 501-273-9561
EDWARD B. DILLON. JR
NICHOLAS THOMPSON
TELEFAX 501-273-0527
S HUBERT MAYES. JR.
FREDERICK K. CAMPBELL
ROBERT M. EUBANKS III. P.A.
WALTER G WRIGHT. JR
LYN PEEPLES PRUITT
WRITER'S DIRECT DIAL
*LICENSED IN DISTRICT OF COLUMBIA AND ARKANSAS
T SCOTT CLEVENGER
ALL OTHERS LICENSED IN ARKANSAS
501-688-8837
PAM FEB " h
February 9, 1994
Ms. Hillary Rodham Clinton
The White House - West Wing
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500-2000
Dear Ms. Clinton:
Alliance of American Insurers had its first opportunity
to testify "on the hill" on the Health Security Act last week
before the Subcommittee on Commerce, Consumer Protection and
Competitiveness of the House Committee on Energy and Commerce.
Thomas Taylor, Executive Vice President and Chief Operating
Officer of Amica Mutual Insurance Company and Chairman of the
Alliance's Special Auto Insurance/Health Care Reform Task Force,
testified that the Alliance supports the goals of health care
reform articulated by you and the President and the concept of
coordination of the medical portions workers' compensation and
auto med pay/liability insurance, but pointed out some problems
we have with specific provisions of Title X. As you know, this
is consistent with the position we took with the Clinton/Gore
staff during the Campaign, with the Health Care Reform Task Force
during its deliberations, with Administration officials during
drafting and now before Congress since introduction of the Plan.
Yet, following the testimony, a Journal of Commerce
article was headlined "Insurers Group Slams Clinton Health Plan."
I was present for Mr. Taylor's testimony and want you to know
that this is a misrepresentation of his remarks and to assure you
that we do not "speak with forked tongue" by telling Congress one
thing and the Administration something different. We now know
how you and the President must feel when some of the press/media
distort some of your statements and their intended meaning. This
inaccurate reporting of our testimony was an "unintended
consequence" but beyond our control.
MITCHELL. WILLIAMS, SELIG, GATES & WOODYARD
A PROFESSIONAL LIMITED COMPANY
Ms. Hillary Rodham Clinton
February 9, 1994
Page 2
We continue our interest in health care reform but
since our 214 member companies provide workers' compensation and
auto insurance products to millions of Americans, our primary
focus and expertise are on the matters addressed by Title X.
Should you or Administration representatives care to discuss
these provisions or positive changes to them outside of the
Congressional arena, we would be happy to meet at any time and
would welcome the opportunity.
Kindest personal regards to you and the President.
Yours very truly,
S. AUBIN Hubert Mayes, Jr.
SHM: la
CC
Ms. Carol Rasco
Assistant to the President,
Domestic Policy
The White House - West Wing
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
I - MISC
August 19, 1994
TO:
Hillary
FROM:
Melanne
CC:
Lisa
RE:
Comments of Johnny Apple on the Charlie Rose Show
Rose asked whether or not HRC appeared to be less public on
health care.
Apple said it was appropriate to have a lower profile in the
congressional phase of health care.
Apple said that "all the plans owe a good deal to her and
her people." He added that HRC is "indispensible" to the
POTUS. She "benefits" the POTUS.
When asked if she is "soured on Washington," he said he had
no information on that but said he'd underscore again that
HRC will get "a lot of credit" if a plan is passed. "There
are a lot people who believe that nothing would have
happened, if it hadn't been for her."
THE WHITE HOUSE
January 10, 1994
Jack B. McConnell, M. D.
Chairman
Volunteers in Medicine Clinic
P. O. Box 23287
Hilton Head Island, SC 29923
Dear Dr. McConnell:
Congratulations on the success of the
Volunteers in Medicine program. It makes
eminent sense, and from what I read in the
New York Times article, benefits everyone
involved.
I will pass on your packet of
materials to the Office of Policy
Development and have someone contact you
for more specific information.
With best wishes for the New Year and
continued success with VIM, I am
Sincerely yours,
Hillary Hillary Rodham Clinton
CC: Office of Policy Development
PHOTOCOPY
PRESERVATION
DA was great visiting
with you-
T
VÍM
CLINIC
VOLUNTEERS
IN MEDICINE
PHOTOCOPY
PRESERVATION
HILTON HEAD ISLAND, SOUTH CAROLINA
CLINIC
MEDICINE NI
VOLUNTEERS
VÍVI
The Funding
The Volunteers in Medicine Clinic has
and the Clinic's first year of operation ($400,000).
received support from a number of local and
Subsequent to its initial fundraising efforts, the VIM
For more information on the VIM Clinic*
regional sources, and several national and charit-
Clinic anticipates on-going financial support from the
able foundations. It is expected that residents and
community through such efforts as an annual fund-
business leaders of Hilton Head Island and
drive, corporate giving, employer contributions plans,
Daufuskie Island will provide the financial support
and a series of special events to be held throughout
necessary to fund Clinic operations.
the year.
VÍM
VOLUNTEERS
Since its conception, the VIM Clinic has
At the national level, the Volunteers in Medi-
IN MEDICINE
received support from local businesses, religious,
cine Clinic will continue to approach foundations and
CLINIC
charitable and service organizations, the Hilton
corporations for grants and contributions.
Head Hospital, and state and local governments.
The following donor categories have been
Post Office Box 23287
Professional medical groups throughout the
designed to offer flexible funding opportunities for
state have also actively supported the Clinic's
individual and corporate contributors:
Hilton Head Island, S.C. 29925-3287
organization.
VIM Founder's Circle
$10,000 and over
Phone: (803) 681-6612
The next step in the development of the
VIM Partner
$ 5,000 $ 9,999
Fax: (803) 681-6614
Volunteers in Medicine Clinic is critical. As the
VIM Gold Patron
$ 2,500 $ 4,999
medical services at the Clinic will be offered to the
VIM Silver Patron
$ 1,000 $ 2,499
medically underserved patients completely free-of-
VIM Bronze patron
$
100 $ 1,000
charge, the Clinic's operational resources must
VIM Friend
up to $100
The Volunteers in Medicine Clinic
come from donated funds.
An employer donation program entitled "Fair
is a recognized 501(c) (3) authorized
A goal of $1 million dollars has been set for the
Share Payer" suggests employer donations based on
charitable organization. All
Clinic's Initial Funding Campaign. These funds will
the number of employees who will utilize the VIM
contributions are tax deductible.
cover estimated facility building costs ($500,000)
Clinic for his/her medical care.
VM CLINIC
The Clinic
The Need
The Volunteers in Medicine (VIM) Clinic is a non-profit volunteer
It is estimated that approximately 15% of the residents of Hilton Head
staffed and operated free medical clinic being established to provide health
Island and Daufuskie Island and a large majority of the workforce which
and wellness services to the medically underserved who live or work on
commutes to the Island now receive little or no primary health care
Hilton Head Island and Daufuskie Island.
services. Reports indicate that a significant number of children entering
A number of business and civic professionals on the Islands and
school in South Carolina have never been seen by a physician.
around the state, as well as leaders from the medically underserved
The VIM Clinic will serve those who live or work on Hilton Head
community have joined with retired medical professionals to develop the
Island and Daufuskie Island who are presently medically underserved. This
VIM Clinic and help it become a reality.
population includes those persons who now receive little or no medical
care.
The Mission
Preliminary census studies indicate approximately 7000-8000 persons
who may be categorized as medically underserved in this area.
The primary mission of the Volunteers in Medicine Clinic is to
understand and serve the health and wellness needs of the medically
underserved population living and/or working on Hilton Head Island and
Daufuskie Island.
Perhaps the vision statement for the Volunteers in Medicine Clinic
best explains its direction:
The Volunteers in Medicine Clinic will not be a full-service clinic nor
May we have eyes to see those who are rendered invisible and excluded,
will it offer the services of a hospital. The VIM Clinic will provide routine
medical care, with the scope of its activities to include the following
Open arms and hearts to reach out and include them,
services:
Healing hands to touch their lives with love,
primary health services
And in the process heal ourselves.
community wellness issues of the medically underserved
The Volunteers
physical examinations
shots and vaccinations
MEDICAL PROFESSIONALS
pre-natal and well baby clinics
More than 100 medical professionals (doctors, dentists, nurses and
other specialists) living in the area will donate their services to the Clinic.
eye examinations
These volunteer medical personnel will be augmented by currently
dental care
practicing professionals who have indicated a desire to contribute their
time and donate their services to the VIM Clinic.
A primary function of the Clinic will be screening and referral to
more comprehensive local and regional medical and social resources when
In addition to primary care, the following specialties will be repre-
sented at the Clinic:
deemed appropriate.
Alergy
Obstetrics/Gynecology
Psychiatry
Anesthesiology
Opthamology
Radiology
Dermatology
Orthopaedics
Surgery
The Facility
General Practice
Pathology
Urology
Internal Medicine
The VIM Clinic is slated open in the fall of 1993. The Town of Hilton
Head Island has granted the VIM Clinic a 30-year lease of a 1.1 acre lot on
COMMUNITY VOLUNTEERS
which the Clinic facility will be built. The location, on the corner of
The community volunteers are a critical and significant factor in the
Palmetto Parkway and Northridge Drive (north end of Hilton Head Island)
success of the VIM Clinic. The VIM volunteers will be considered
provides for easy access by those who will be served by the VIM Clinic.
"partners in care" as they greet patients and escort them through the
The hours of operation will be adjusted to accommodate the needs of the
patient care process, offer explanation of Clinic procedures and services
patient population.
and let Clinic patients know that someone hears their problems and cares
The facility and its staff are covered by the Joint Underwriters
about them as individuals. Community volunteers will also provide
Association. This Association has provided full malpractice insurance
operational and administrative support for the Clinic.
coverage for all volunteers working in the VIM Clinic.
eContribution
YES!
I am interested in making a contribution to the Volunteers in Medicine Clinic.
Please make checks payable to: Volunteers in Medicine Clinic
I. I have enclosed:
(
)
My tax deductible gift* of $
NAME
(
) A matching gift form from:
HOME ADDRESS
II. I piedge to contribute $
during the calendar year 1993.
CITY
STATE
ZIP
Please send me reminders:
(
)
monthly
(
)
quarterly
HOME PHONE (
)
( ) specified dates:
BUSINESS NAME AND ADDRESS:
III. 1 would like to become a Volunteers In Medicine Donor.
(Contribution levels described on reserve side)
( ) VIM Friend
$
( ) VIM Bronze Patron
$
( ) VIM Silver Patron
$
( ) VIM Gold Patron
$
( ) VIM Partner
$
BUSINESS PHONE (
)
( ) VIM Founder's Circle
$
VÍM
VOLUNTEERS
IN MEDICINE
CLINIC
HIGH-QUALITY/LOW-COST PRIMARY HEALTH CARE
Our health care system may not be terminal but it needs some
urgent attention. One of the critical problems the President
highlighted was the shortage of primary care physicians. In
contrast to Canada, with 50 percent of their physicians engaged
in primary care, and England, with 70 percent, we have only 29
percent in the United States.
The President's suggestion was to decrease the number of
specialty training programs and increase the number of primary
care training programs. It would be unfortunate if we took that
approach.
Even with our acknowledged shortcomings, our health care system
is still the envy of the world. We have the highest quality
clinical research and care in the world. Much of our well
deserved reputation is due to the number and quality of our
specialists.
We have created a physician specialty training system which will
continue to turn out the best and brightest clinicians -- if we
don't tinker with it. If we do, we will soon see an erosion of
the sort of high-quality clinical specialty care and research
which we and the world have learned to expect -- and which only
our system is able to provide.
The President's suggestion to increase the number of primary
care training programs makes sense as a long-term solution. But
it will take decades before the impact of that approach will
provide any significant benefit.
There is an approach to high-quality/low-cost primary care which
could be undertaken almost immediately, does not involve
tinkering with the present system, employs unused resources, and
does not interfere with the major elements of the President's
program. It is the use of retired medical personnel to provide
primary health care for the medically underserved.
This suggestion is not made in a vacuum. A small group of
individuals on Hilton Head, South Carolina has created The
Volunteers in Medicine Clinic using retired medical personnel.
Post Office Box 23287
Hilton Head Island, S.C. 29925-3287
(803) 681-6612 Fax (803) 681-6614
VÍM
VOLUNTEERS
IN MEDICINE
CLINIC
Our Mission is to understand and serve the health and wellness
needs of the medically underserved who live or work on the
island. We will provide a complete scope of primary health
services including vaccinations, physicals, primary care,
special diagnostic and therapeutic clinics, minor surgery, eye
care, hearing care, and dental care -- all free of charge!
The services will be delivered by the retired medical personnel
who live on Hilton Head. To date 57 physicians, 12 dentists,
and 90 nurses have enrolled in the program. In addition, 74
community members have volunteered their services. All of them
serving without compensation.
While Hilton Head has a generous supply of retired medical
personnel, the clinic is being developed so it can be replicated
anywhere in the United States by one physician and one nurse.
The United States is ignoring a valuable resource. Thousands of
mature, experienced and caring physicians, dentists and nurses
could be available almost immediately to provide primary health
care.
If President Clinton established a small incentive -- perhaps
forgiveness of a portion of the taxes of their savings plan
stretched out over eight or ten years -- a pool of 100,000 or
more retired physicians could be created almost immediately to
take on the primary care dilemma for the country. In exchange
for the tax advantage the physicians would be required to work
half-time free-of-charge in a not-for-profit primary health
clinic.
Equipment, materials, and pharmaceuticals will be essential, and
an incentive tax advantage could be provided for those companies
who contribute these items to the clinics.
I would be delighted to show you The Hilton Head Volunteers in
Medicine Clinic and discuss the idea with you further if you are
interested.
Jack Jack B. B McConnell, me Anmell,md M.D.
Post Office Box 23287
Hilton Head Island, S.C. 29925-3287
(803) 681-6612 Fax (803) 681-6614
8
Y
THE NEW YORK TIMES NATIONAL SATURDAY, DECEMBER 25, 1993
Free Clinic Provides Model for Nation
By LINDSEY GRUSON
Retired doctors
cover full costs. "My eyes nearly fell
Special 10 The New York Times
out of my head when my pediatrician
HILTON HEAD, S.C. - Every time
told me his prices," said Maile Rober-
Dr. Jack B. McConnell left his dream
show a way to
son, who moved here last month from
home here for the brief drive to the
Nevada with her husband, Jeff.
store, he passed through a nightmare.
cut medical costs.
Mrs. Roberson said medical bills
The three-mile trip took him past his
were breaking the family's tight budg-
yacht club and golf club to roads lined
et even though her husband had health
with leaky clapboard houses without
insurance through his job as chief of
heat, running water or sewage dispos-
engineering at the Hyatt Hotel, one of
al.
South Carolina studded with pines and
the most luxurious resorts on this san-
palmettos.
"It's a short drive, but a hell of a long
dal-shaped island. So she recently took
journey," said the 68-year-old doctor,
'Model for the Nation'
their 18-month-old son, Tyler, to the
who moved here four years ago from
clinic for an examination and vaccina-
"It's a tremendous thing, a model for
New Jersey after retiring as corporate
tion.
the nation," said Gov. Carroll A. Camp-
director of advanced technology for
bell Jr., who helped pass legislation
The center, Volunteers in Medicine,
Johnson & Johnson. "Sitting cheek by
enabling the clinic to operate without
is staffed almost entirely by 200 retired
jowl, you couldn't ignore the squalor. I
buying expensive malpractice insur-
doctors and other medical profession-
couldn't drive by it and not ask why?"
ance. "This is people, not government,
als, many of whom who say the attrac-
tion is liberation from the fear of mal-
What began as a gnawing question
solving the problem. This is really what
has now turned into a clinic where
we ought to be doing around the coun-
practice suits and insurance compa-
volunteer doctors, most of them re-
try."
nies' mountainous paperwork. The
tired, began this summer to offer free
Even people with health insurance
bulk of the equipment and supplies are
donated.
medical care from a temporary office
through an employer have chosen the
to residents of this seaside slice of
clinic when the insurance policy fails to
"This brings me back to my true
love," said Dr. Sherman Gans, a 57-
year-old volunteer who moved here
three years ago after selling his Bronx
dental practice. "I retired from 30
years of raising and supporting a fam-
ily to a second honeymoon and a life of
recreation But no matter how wonder-
ful recreation is, the dentistry spark is
Wade Spees for The New York Times
still there. Now I can put my life back
The Volunteers in Medicine clinic in Hilton Head, S.C., is staffed mostly by retired doctors and medical
together."
professionals. Maryann DeYoung, a nurse, gave Chandler Almond her shots as her mother, Beth, waited.
The clinic is intended to serve as a
prototype for other communities. If
copied around the nation, organizers
nually graduate from medical school.
say it would slash the nation's health
"It's the greatest thing since toasted
smaller staff of retired medical people
He says many of the retirees can be
bread," Dr. Long said. "There's noth-
could offer some care. Still, he worries
care bill. Even better, they say, it
enticed into returning to medicine's
ing bad - with religion, mother nature,
that the idea's implementation could
would create a reservoir of desperate-
front lines by exempting them from
ly needed family doctors overnight,
good ripe apples, flowers in spring, or
be counterproductive, providing a
malpractice suits, as states already do
this. It's first-class medical care with-
finessing onerous proposals to force
strong incentive for employers to drop
for doctors who stop to help victims of
out the taint of financial considera-
young doctors into general practice by
their employees' health insurance cov-
highway accidents.
tions."
erage and for "the greedy to pretend to
curtailing the training of specialists.
Supporters say the clinic will help
The clinic, temporarily housed in a
be needy" in large numbers.
From Skeptic to Supporter
reduce expenses at the local hospital,
building donated by the town hospital,
The state medical establishment has
which has cared for many uninsured
"What's needed is to increase the
is still raising money to build a perma-
expressed concerns about insuring the
patients. Steven A. Caywood, president
nent home. At that time organizers
continuing competence and medical
number of people providing primary
and chief operating officer of the Hilton
care without cutting our noses off," Dr.
plan to be more aggressive in market-
currency of the aging staff, many of
Head Hospital, said it cost his emer-
ing the free medical care. Already,
whom were trained decades ago. But
McConnell said. "It would be a pity to
gency room more than 20 times as
there is interest from other states. Offi-
supporters of the center say the poten-
solve our problem by destroying the
much as Dr. McConnell's clinic to treat
cials at Catholic Charities and St. Pe-
tial problems are insignificant com-
most advanced health care system in
a developing case of pneumonia. "The
ter's Medical Center, a 416-bed com-
pared with the benefits.
the world, the envy of the world, when,
person isn't going to get out of here
munity teaching hospital in New
"This is fantastic and very much
at a very modest cost, you can create a
without a couple hundred dollars in
Brunswick, N.J., say they are develop-
needed," said Thomas Barnwell Jr., a
pool of physicians practicing for free.
tests," Mr. Caywood said.
ing plans for a similar clinic in central
third-generation native of Hilton Head
And best of all, you haven't tinkered
Dr. Paul Long, an internist who has
New Jersey.
and community organizer who is build-
with our strengths and you've kept the
practiced on the island for 18 years,
Dr. McConnell acknowledges that,
ing low-income housing. "It's going to
government out of health care."
said that he had been a skeptic, like the
unlike this seaside resort, many areas
be the glue of this community. It's
Dr. McConnell notes that about
rest of the local medical community,
of the country do not have enough
going to bring people together, bind
120,000 doctors retire every year, about
but that he was now an ardent support-
retired medical people to run a full-
them together and glue them together
the same number of students that an-
er.
service clinic. But he said that even a
like nothing before."
The Clinic
MM CLINIC
The Volunteers in Medicine (VIM) Clinic is a non-profit volunteer staffed and operated free medical clinic being
established to provide health and wellness services to the medically underserved who live or work on Hilton Head
Island and Daufuskie Island.
A number of business and civic professionals on the Islands and around the state, as well as leaders from the
medically underserved community have joined with retired medical professionals to develop the VIM Clinic and help it
become a reality.
The Mission
The primary mission of the Volunteers in Medicine Clinic is to understand and serve the health and wellness
needs of the medically underserved population living and/or working on Hilton Head Island and Daufuskie Island.
Perhaps the vision statement for the Volunteers in Medicine Clinic best explains its direction:
May we have eyes to see those who are rendered invisible and excluded,
Open arms and hearts to reach out and include them,
Healing hands to touch their lives with love,
And in the process heal ourselves.
The Volunteers
MEDICAL PROFESSIONALS
More than 100 medical professionals (doctors, dentists, nurses and other specialists) living in the area will donate
their services to the Clinic. These volunteer medical personnel will be augmented by currently practicing professionals
who have indicated a desire to contribute their time and donate their services to the VIM Clinic.
In addition to primary care, the following specialties will be represented at the Clinic:
Allergy
Obstetrics/Gynecology
Psychiatry
Anesthesiology
Opthamology
Radiology
Dermatology
Orthopaedics
Surgery
General Practice
Pathology
Urology
Internal Medicine
Pediatrics
VOLUNTEERS IN MEDICINE ORGANIZATION
BOARD OF
CHAIRMAN
TRUSTEES
C.E.O.
PEER REVIEW
COMMITTEE
CLINIC
DIRECTOR
ADMINISTRATION
MEDICAL
DIRECTOR
COMMUNITY
FUND RAISING
VOLUNTEERS
MEDICAL
DIRECTOR OF
DIRECTOR
DIRECTOR OF
ANCILLARY
EDUCATION
DENTISTS
OF NURSES
NURSE EDUCATION
SERVICES
EDUCATION
EDUCATION
COMMUNITY VOLUNTEERS
The community volunteers are a critical and significant factor in the success of the VIM Clinic. The VIM volunteers
will be considered "partners in care" as they greet patients and escort them through the patient care process, offer
explanation of Clinic procedures and services and let Clinic patients know that someone hears their problems and cares
about them as individuals. Community volunteers will also provide operational and administrative support for the Clinic.
The Services
The Volunteers in Medicine Clinic will not be a full-service clinic nor will it offer the services of a hospital.
The VIM Clinic will provide routine medical care, with the scope of its activities to include the following services:
primary health services
community wellness issues of the medically underserved
physical examinations
shots and vaccinations
pre-natal and well baby clinics
eye examinations
dental care
A primary function of the Clinic will be screening and referral to more comprehensive local and regional
medical and social resources when deemed appropriate.
VÍM
VOLUNTEERS
IN MEDICINE
CLINIC
The Facility
The VIM Clinic is slated open in the fall of 1993. The Town of Hilton Head Island has granted the VIM Clinic a
30-year lease of a 1.1 acre lot on which the Clinic facility will be built. The location, on the corner of Palmetto Parkway
and Northridge Drive (north end of Hilton Head Island) provides for easy access by those who will be served by the
VIM Clinic. The hours of operation will be adjusted to accommodate the needs of the patient population.
The facility and its staff are covered by the Joint Underwriters Association. This Association has provided full
malpractice insurance coverage for all volunteers working in the VIM Clinic.
FILM PROCESS
RESTROOM
EGRESS
EXAM #1
EXAM #2
EXAM #3
EXAM #4
EXAM #5
TRAINING
CLEAN/UTILITY
LAUNDRY
X-RAY
STAFF LOUNGE
STR.
STR.
SUB/WAITING
STORAGE
MINOR PROCEDURE
CLINIC NURSING
LAB
SERVICE ENTRANCE
EYE EXAM
WEIGH-IN
REST
ROOM
STORAGE
STORAGE ROOM
DENTAL
READING
INTERVIEW &
REGISTRATION
SERVICE
WAITING ROOM
IN-SERVICE
SOCIAL SERVICES
DENTAL
READING
EDUCATION
SERVICE
VENDING
RECEPTION AREA
PHARMACY
REST ROOM
NURSE DIRECTOR
WORK
COPYING
ROOM
BOARD ROOM
REST ROOM
PEDIATRIC PLAY
ENTRY/VEST.
MEDICAL DIRECTOR
CLERICAL
CLINIC MANAGER
CLINIC
ENTRANCE
PROJECTED FACILITY FLOOR PLAN
The Funding
The Volunteers in Medicine Clinic has received support from a number of local and regional sources, and several
national and charitable foundations. It is expected that residents and business leaders of Hilton Head Island and
Daufuskie Island will provide the financial support necessary to fund Clinic operations.
Since its conception, the VIM Clinic has received support from local businesses, religious, charitable and service
organizations, the Hilton Head Hospital, and state and local governments. Professional medical groups throughout the
state have also actively supported the Clinic's organization.
The next step in the development of the Volunteers in Medicine Clinic is critical. As the medical services at the
Clinic will be offered to the medically underserved patients completely free-of-charge, the Clinic's operational resources
must come from donated funds.
A goal of $1 million dollars has been set for the Clinic's Initial Funding Campaign. These funds will cover esti-
mated facility building costs ($500,000) and the Clinic's first year of operation ($400,000). Subsequent to its initial
fundraising efforts, the VIM Clinic anticipates on-going financial support from the community through such efforts as
an annual fund-drive, corporate giving, employer contributions plans, and a series of special events to be held through-
out the year.
At the national level, the Volunteers in Medicine Clinic will continue to approach foundations and corporations for
grants and contributions.
The following donor categories have been designed to offer flexible funding opportunities for individual and
corporate contributors:
VIM Founder's Circle
$10,000 and over
VIM Partner
$ 5,000 $ 9,999
VIM Gold Patron
$ 2,500 $ 4,999
VIM Silver Patron
$ 1,000 $ 2,499
VIM Bronze patron
$ 100 $ 1,000
VIM Friend
up to $100
An employer donation program entitled "Fair Share Payer" suggests employer donations based on the number of
employees who will utilize the VIM Clinic for his/her medical care.
VÍM
VOLUNTEERS
IN MEDICINE
CLINIC
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
002. memo
From: Jennifer Klein, To: Hillary Rodham Clinton, Re: Telephone
2/18/94
b(7)(E)
Calls [partial] (1 page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
gomp
TO:
Hillary Rodham Clinton
FROM:
DATE:
Jennifer 2/18/94 Klein J.Klem
RE:
Telephone Calls
I spoke this week with Drs. Jeffry Lindenbaum and Jack
McConnell to follow up on letters that they had written to you.
(b)(7)e
002
(b)(7)e
You had asked us to ask Andrew
Friendly if the President met him. The President did not meet
him this year but did last year. Dr. Lindenbaum is concerned
about primary care providers. He was not particularly interested
in hearing about the Health Security Act's emphasis on prevention
and on the workforce initiatives to increase the supply of
primary care providers. He really just wanted to be heard.
I spoke with Dr. McConnell, the Chairman of the Volunteers
in Medicine Clinic, at length about his program and about the
Health Security Act. Through the Volunteers in Medicine Clinic,
retired health care professionals provide basic medical services
to low-income individuals in the community at no charge.
Approximately 60 physicians, 75 nurses and 13 dentists currently
volunteer at the clinic. Dr. McConnell told me that 22
communities in 19 states are planning to open similar clinics. I
have more detailed information about the funding and operation of
the clinic if you are interested.
Both were extremely pleased that you had made the effort to
follow through. I told them to feel free to contact me with any
further comments or questions.
Jennifer - HRC
would like some-
one to call
Dr. Mc Connell
who should do
that? She saw
at Renaissance
him Pan
THE WHITE HOUSE
]
January 10, 1994
Jack B. McConnell, M. D.
Chairman
Volunteers in Medicine Clinic
P. O. Box 23287
Hilton Head Island, SC 29923
Dear Dr. Jack McConnell:
Congratulations on the success of the
Volunteers in Medicine program. It makes
eminent sense, and from what I read in the
New York Times article, benefits everyone
involved.
I will pass on your packet of
materials to the Office of Policy
Development and have someone contact you
for more specific information.
With best wishes for the New Year and
continued success with VIM, I am
Sincerely yours,
Hillary Hillary Rodham Clinton
CC: Office of Policy Development
DA was great visiting
with you
8
Y
THE
NEW
YORK
TIMES
NATIONAL
SATURDAY,
DECEMBER
25,
1993
Free Clinic Provides Model for Nation
By LINDSEY GRUSON
Retired doctors
cover full costs. "My eyes nearly fell
Special to The New York Times
out of my head when my pediatrician
HILTON HEAD, S.C. - Every time
told me his prices," said Maile Rober-
Dr. Jack B. McConnell left his dream
show a way to
son, who moved here last month from
home here for the brief drive to the
Nevada with her husband, Jeff.
store, he passed through a nightmare.
cut medical costs.
Mrs. Roberson said medical bills
The three-mile trip took him past his
were breaking the family's tight budg-
yacht club and golf club to roads lined
et even though her husband had health
with leaky clapboard houses without
insurance through his job as chief of
heat, running water or sewage dispos-
engineering at the Hyatt Hotel, one of
al.
South Carolina studded with pines and
the most luxurious resorts on this san-
"It's a short drive, but a hell of a long
palmettos.
dal-shaped island. So she recently took
journey," said the 68-year-old doctor,
'Model for the Nation'
their 18-month-old son, Tyler, to the
who moved here four years ago from
clinic for an examination and vaccina-
"It's a tremendous thing, a model for
New Jersey after retiring as corporate
tion.
the nation," said Gov. Carroll A. Camp-
director of advanced technology for
bell Jr., who helped pass legislation
The center, Volunteers in Medicine,
Johnson & Johnson. "Sitting cheek by
enabling the clinic to operate without
is staffed almost entirely by 200 retired
jowl, you couldn't ignore the squalor. I
buying expensive malpractice insur-
doctors and other medical profession-
couldn't drive by it and not ask why?"
ance. This is people, not government,
als, many of whom who say the attrac-
What began as a gnawing question
tion is liberation from the fear of mal-
solving the problem. This is really what
has now turned into a clinic where
we ought to be doing around the coun-
practice suits and insurance compa-
volunteer doctors, most of them re-
nies' mountainous paperwork. The
try.
tired, began this summer to offer free
Even people with health insurance
bulk of the equipment and supplies are
donated.
medical care from a temporary office
through an employer have chosen the
to residents of this seaside slice of
clinic when the insurance policy fails to
"This brings me back to my true
love," said Dr. Sherman Gans, a 57-
year-old volunteer who moved here
three years ago after selling his Bronx
dental practice. "I retired from 30
years of raising and supporting a fam-
ily to a second honeymoon and a life of
recreation. But no matter how wonder-
ful recreation is, the dentistry spark is
Wade Spees for The New York Times
still there. Now I can put my life back
The Volunteers in Medicine clinic in Hilton Head, S.C., is staffed mostly by retired doctors and medical
together.'
professionals. Maryann DeYoung, a nurse, gave Chandler Almond her shots as her mother, Beth, waited.
The clinic is intended to serve as a
prototype for other communities. If
copied around the nation, organizers
nually graduate from medical school.
say it would slash the nation's health
"It's the greatest thing since toasted
smaller staff of retired medical peop
He says many of the retirees can be
care bill. Even better, they say, it
bread," Dr. Long said. 'There's noth-
could offer some care. Still, he worri
enticed into returning to medicine's
would create a reservoir of desperate-
ing bad - with religion, mother nature,
that the idea's implementation cou'
front lines by exempting them from
ly needed family doctors overnight,
good ripe apples, flowers in spring, or
be counterproductive, providing
malpractice suits, as states already do
this. It's first-class medical care with-
finessing onerous proposals to force
strong incentive for employers to dro
for doctors who stop to help victims of
out the taint of financial considera-
young doctors into general practice by
their employees' health insurance CO
highway accidents.
tions."
curtailing the training of specialists.
erage and for "the greedy to pretend
Supporters say the clinic will help
The clinic, temporarily housed in a
be needy" in large numbers.
From Skeptic to Supporter
reduce expenses at the local hospital,
building donated by the town hospital,
The state medical establishment ha
which has cared for many uninsured
"What's needed is to increase the
is still raising money to build a perma-
expressed concerns about insuring ti
patients. Steven A. Caywood, president
number of people providing primary
nent home. At that time organizers
continuing competence and medic.
and chief operating officer of the Hilton
care without cutting our noses off, Dr.
plan to be more aggressive in market-
currency of the aging staff, many
Head Hospital, said it cost his emer-
McConnell said. "It would be a pity to
ing the free medical care. Already,
whom were trained decades ago. B¹
gency room more than 20 times as
there is interest from other states. Offi-
solve our problem by destroying the
supporters of the center say the pote:
much as Dr. McConnell's clinic to treat
cials at Catholic Charities and St. Pe-
most advanced health care system in
tial problems are insignificant con
a developing case of pneumonia. "The
ter's Medical Center, a 416-bed com-
the world, the envy of the world, when,
pared with the benefits.
person isn't going to get out of here
at a very modest cost, you can create a
munity teaching hospital in New
"This is fantastic and very muc
without a couple hundred dollars in
pool of physicians practicing for free.
Brunswick, N.J., say they are develop-
needed," said Thomas Barnwell Jr.,
tests," Mr. Caywood said.
And best of all, you haven't tinkered
ing plans for a similar clinic in central
third-generation native of Hilton Hea
Dr. Paul Long, an internist who has
with our strengths and you've kept the
New Jersey.
and community organizer who is buil
practiced on the island for 18 years,
government out of health care."
Dr. McConnell acknowledges that,
ing low-income housing. "It's going
said that he had been a skeptic, like the
unlike this seaside resort, many areas
be the glue of this community. It
Dr. McConnell notes that about
rest of the local medical community,
of the country do not have enough
going to bring people together, bin
120,000 doctors retire every year, about
but that he was now an ardent support-
retired medical people to run a full-
them together and glue them togeth
the same number of students that an-
er.
service clinic. But he said that even a
like nothing before.'
VOLUNTEERS IN MEDICINE CLINIC
Pam - Do letter congrats t on care project
etc r Jack get B. McConnell, someone M.D.
to get Specific Chairman
P.O. Box 23287, Hilton Head Island, South Carolina 29925
Telephone (803) 681-6612 Fax (803) 681-6614
Home Phone- 803-681-9348
PHOTOCOPY
HRC HANDWRITING
HILTON HEAD ISLAND, SOUTH CAROLINA
CLINIC
MEDICINE NI
VOLUNTEERS
VIVI
The Funding
The Volunteers in Medicine Clinic has
and the Clinic's first year of operation ($400,000).
received support from a number of local and
Subsequent to its initial fundraising efforts, the VIM
For more information on the VIM Clinic
regional sources, and several national and charit-
Clinic anticipates on-going financial support from the
able foundations. It is expected that residents and
community through such efforts as an annual fund-
business leaders of Hilton Head Island and
drive, corporate giving, employer contributions plans,
Daufuskie Island will provide the financial support
and a series of special events to be held throughout
necessary to fund Clinic operations.
the year.
VÍM
VOLUNTEERS
Since its conception, the VIM Clinic has
At the national level, the Volunteers in Medi-
IN MEDICINE
received support from local businesses, religious,
cine Clinic will continue to approach foundations and
CLINIC
charitable and service organizations, the Hilton
corporations for grants and contributions.
Head Hospital, and state and local governments.
The following donor categories have been
Post Office Box 23287
Professional medical groups throughout the
designed to offer flexible funding opportunities for
state have also actively supported the Clinic's
individual and corporate contributors:
Hilton Head Island, S.C. 29925-3287
organization.
VIM Founder's Circle
$10,000 and over
Phone: (803) 681-6612
The next step in the development of the
VIM Partner
$ 5,000 $ 9,999
Fax: (803) 681-6614
Volunteers in Medicine Clinic is critical. As the
VIM Gold Patron
$ 2,500 $ 4,999
medical services at the Clinic will be offered to the
VIM Silver Patron
$ 1,000 $ 2,499
medically underserved patients completely free-of-
VIM Bronze patron
$
100 $ 1,000
charge, the Clinic's operational resources must
VIM Friend
up to $100
The Volunteers in Medicine Clinic
come from donated funds.
An employer donation program entitled "Fair
is a recognized 501(c) (3) authorized
A goal of $1 million dollars has been set for the
Share Payer" suggests employer donations based on
charitable organization. All
Clinic's Initial Funding Campaign. These funds will
the number of employees who will utilize the VIM
contributions are tax deductible.
cover estimated facility building costs ($500,000)
Clinic for his/her medical care.
CLINIC ИЙ
Clinic
The Need
The Volunteers in Medicine (VIM) Clinic is a non-profit volunteer
It is estimated that approximately 15% of the residents of Hilton Head
staffed and operated free medical clinic being established to provide health
Island and Daufuskie Island and a large majority of the workforce which
and wellness services to the medically underserved who live or work on
commutes to the Island now receive little or no primary health care
Hilton Head Island and Daufuskie Island.
services. Reports indicate that a significant number of children entering
A number of business and civic professionals on the Islands and
school in South Carolina have never been seen by a physician.
around the state, as well as leaders from the medically underserved
The VIM Clinic will serve those who live or work on Hilton Head
community have joined with retired medical professionals to develop the
Island and Daufuskie Island who are presently medically underserved. This
VIM Clinic and help it become a reality.
population includes those persons who now receive little or no medical
care.
The Mission
Preliminary census studies indicate approximately 7000-8000 persons
who may be categorized as medically underserved in this area.
The primary mission of the Volunteers in Medicine Clinic is to
understand and serve the health and wellness needs of the medically
underserved population living and/or working on Hilton Head Island and
Daufuskie Island.
The Services
Perhaps the vision statement for the Volunteers in Medicine Clinic
best explains its direction:
The Volunteers in Medicine Clinic will not be a full-service clinic nor
May we have eyes to see those who are rendered invisible and excluded,
will it offer the services of a hospital. The VIM Clinic will provide routine
medical care, with the scope of its activities to include the following
Open arms and hearts to reach out and include them,
services:
Healing hands to touch their lives with love,
primary health services
And in the process heal ourselves.
community wellness issues of the medically underserved
The Volunteers
physical examinations
shots and vaccinations
MEDICAL PROFESSIONALS
pre-natal and well baby clinics
More than 100 medical professionals (doctors, dentists, nurses and
other specialists) living in the area will donate their services to the Clinic.
eye examinations
These volunteer medical personnel will be augmented by currently
dental care
practicing professionals who have indicated a desire to contribute their
time and donate their services to the VIM Clinic.
A primary function of the Clinic will be screening and referral to
more comprehensive local and regional medical and social resources when
In addition to primary care, the following specialties will be repre-
sented at the Clinic:
deemed appropriate.
Alergy
Obstetrics/Gynecology
Psychiatry
Anesthesiology
Opthamology
Radiology
Dermatology
Orthopaedics
Surgery
The Facility
General Practice
Pathology
Urology
Internal Medicine
The VIM Clinic is slated open in the fall of 1993. The Town of Hilton
Head Island has granted the VIM Clinic a 30-year lease of a 1.1 acre lot on
COMMUNITY VOLUNTEERS
which the Clinic facility will be built. The location, on the corner of
The community volunteers are a critical and significant factor in the
Palmetto Parkway and Northridge Drive (north end of Hilton Head Island)
success of the VIM Clinic. The VIM volunteers will be considered
provides for easy access by those who will be served by the VIM Clinic.
"partners in care" as they greet patients and escort them through the
The hours of operation will be adjusted to accommodate the needs of the
patient care process, offer explanation of Clinic procedures and services
patient population.
and let Clinic patients know that someone hears their problems and cares
The facility and its staff are covered by the Joint Underwriters
about them as individuals. Community volunteers will also provide
Association. This Association has provided full malpractice insurance
operational and administrative support for the Clinic.
coverage for all volunteers working in the VIM Clinic.
The Contribution
YES!
I am interested in making a contribution to the Volunteers in Medicine Clinic.
Please make checks payable to: Volunteers in Medicine Clinic
I. I have enclosed:
(
)
My tax deductible gift* of $
NAME
(
)
A matching gift form from:
HOME ADDRESS
II. I pledge to contribute S
during the calendar year 1993.
CITY
STATE
ZIP
Please send me reminders:
(
)
monthly
(
)
quarterly
HOME PHONE (
)
( ) specified dates:
BUSINESS NAME AND ADDRESS:
III. I would like to become a Volunteers In Medicine Donor.
(Contribution levels described on reserve side)
( ). VIM Friend
$
( ) VIM Bronze Patron
$
( ) VIM Silver Patron
$
( ) VIM Gold Patron
$
( ) VIM Partner
$
BUSINESS PHONE (
)
( ) VIM Founder's Circle
$
VÍM
VOLUNTEERS
IN MEDICINE
CLINIC
HIGH-QUALITY/LOW-COST PRIMARY HEALTH CARE
Our health care system may not be terminal but it needs some
urgent attention. One of the critical problems the President
highlighted was the shortage of primary care physicians. In
contrast to Canada, with 50 percent of their physicians engaged
in primary care, and England, with 70 percent, we have only 29
percent in the United States.
The President's suggestion was to decrease the number of
specialty training programs and increase the number of primary
care training programs. It would be unfortunate if we took that
approach.
Even with our acknowledged shortcomings, our health care system
is still the envy of the world. We have the highest quality
clinical research and care in the world. Much of our well
deserved reputation is due to the number and quality of our
specialists.
We have created a physician specialty training system which will
continue to turn out the best and brightest clinicians -- if we
don't tinker with it. If we do, we will soon see an erosion of
the sort of high-quality clinical specialty care and research
which we and the world have learned to expect -- and which only
our system is able to provide.
The President's suggestion to increase the number of primary
care training programs makes sense as a long-term solution. But
it will take decades before the impact of that approach will
provide any significant benefit.
There is an approach to high-quality/low-cost primary care which
could be undertaken almost immediately, does not involve
tinkering with the present system, employs unused resources, and
does not interfere with the major elements of the President's
program. It is the use of retired medical personnel to provide
primary health care for the medically underserved.
This suggestion is not made in a vacuum. A small group of
individuals on Hilton Head, South Carolina has created The
Volunteers in Medicine Clinic using retired medical personnel.
Post Office Box 23287
Hilton Head Island, S.C. 29925-3287
(803) 681-6612 Fax (803) 681-6614
VÍM
VOLUNTEERS
IN MEDICINE
CLINIC
Our Mission is to understand and serve the health and wellness
needs of the medically underserved who live or work on the
island. We will provide a complete scope of primary health
services including vaccinations, physicals, primary care,
special diagnostic and therapeutic clinics, minor surgery, eye
care, hearing care, and dental care -- all free of charge!
The services will be delivered by the retired medical personnel
who live on Hilton Head. To date 57 physicians, 12 dentists,
and 90 nurses have enrolled in the program. In addition, 74
community members have volunteered their services. All of them
serving without compensation.
While Hilton Head has a generous supply of retired medical
personnel, the clinic is being developed so it can be replicated
anywhere in the United States by one physician and one nurse.
The United States is ignoring a valuable resource. Thousands of
mature, experienced and caring physicians, dentists and nurses
could be available almost immediately to provide primary health
care.
If President Clinton established a small incentive -- perhaps
forgiveness of a portion of the taxes of their savings plan
stretched out over eight or ten years -- a pool of 100,000 or
more retired physicians could be created almost immediately to
take on the primary care dilemma for the country. In exchange
for the tax advantage the physicians would be required to work
half-time free-of-charge in a not-for-profit primary health
clinic.
Equipment, materials, and pharmaceuticals will be essential, and
an incentive tax advantage could be provided for those companies
who contribute these items to the clinics.
I would be delighted to show you The Hilton Head Volunteers in
Medicine Clinic and discuss the idea with you further if you are
interested.
Jack B. B McConnell, me M.D.
Post Office Box 23287
Hilton Head Island, S.C. 29925-3287
(803) 681-6612 Fax (803) 681-6614
8
Y
THE NEW YORK TIMES NATIONAL SATURDAY, DECEMBER 25, 1993
Free Clinic Provides Model for Nation
By LINDSEY GRUSON
Retired doctors
cover full costs. "My eyes nearly fell
Special to The New York Times
out of my head when my pediatrician
HILTON HEAD, S.C. - Every time
told me his prices," said Maile Rober-
Dr. Jack B. McConnell left his dream
show a way to
son, who moved here last month from
home here for the brief drive to the
Nevada with her husband, Jeff.
store, he passed through a nightmare.
cut medical costs.
Mrs. Roberson said medical bills
The three-mile trip took him past his
were breaking the family's tight budg-
yacht club and golf club to roads lined
et even though her husband had health
with leaky clapboard houses without
insurance through his job as chief of
heat, running water or sewage dispos-
engineering at the Hyatt Hotel, one of
South Carolina studded with pines and
the most luxurious resorts on this san-
al.
palmettos.
"It's a short drive, but a hell of a long
dal-shaped island. So she recently took
journey," said the 68-year-old doctor,
'Model for the Nation'
their 18-month-old son, Tyler, to the
who moved here four years ago from
clinic for an examination and vaccina-
"It's a tremendous thing, a model for
tion.
New Jersey after retiring as corporate
the nation," said Gov. Carroll A. Camp-
director of advanced technology for
bell Jr., who helped pass legislation
The center, Volunteers in Medicine,
Johnson & Johnson. "Sitting cheek by
enabling the clinic to operate without
is staffed almost entirely by 200 retired
jowl, you couldn't ignore the squalor. I
buying expensive malpractice insur-
doctors and other medical profession-
couldn't drive by it and not ask why?"
ance. "This is people, not government,
als, many of whom who say the attrac-
tion is liberation from the fear of mal-
What began as a gnawing question
solving the problem. This is really what
has now turned into a clinic where
we ought to be doing around the coun-
practice suits and insurance compa-
volunteer doctors, most of them re-
nies' mountainous paperwork. The
try."
tired, began this summer to offer free
Even people with health insurance
bulk of the equipment and supplies are
donated.
medical care from a temporary office
through an employer have chosen the
to residents of this seaside slice of
clinic when the insurance policy fails to
"This brings me back to my true
love," said Dr. Sherman Gans, a 57-
year-old volunteer who moved here
three years ago after selling his Bronx
dental practice. "I retired from 30
years of raising and supporting a fam-
ily to a second honeymoon and a life of
recreation. But no matter how wonder-
ful recreation is, the dentistry spark is
Wade Spees for The New York Times
still there. Now I can put my life back
The Volunteers in Medicine clinic in Hilton Head, S.C., is staffed mostly by retired doctors and medical
together.'
professionals. Maryann DeYoung, a nurse, gave Chandler Almond her shots as her mother, Beth, waited.
The clinic is intended to serve as a
prototype for other communities. If
copied around the nation, organizers
nually graduate from medical school.
"It's the greatest thing since toasted
smaller staff of retired medical people
say it would slash the nation's health
He says many of the retirees can be
bread," Dr. Long said. "There's noth-
could offer some care. Still, he worries
care bill. Even better, they say, it
enticed into returning to medicine's
ing bad - with religion, mother nature,
that the idea's implementation could
would create a reservoir of desperate-
front lines by exempting them from
good ripe apples, flowers in spring, or
be counterproductive, providing a
ly needed family doctors overnight,
malpractice suits, as states already do
this. It's first-class medical care with-
strong incentive for employers to drop
finessing onerous proposals to force
for doctors who stop to help victims of
out the taint of financial considera-
their employees' health insurance cov-
young doctors into general practice by
highway accidents.
tions."
erage and for "the greedy to pretend to
curtailing the training of specialists.
Supporters say the clinic will help
The clinic, temporarily housed in a
be needy" in large numbers.
From Skeptic to Supporter
reduce expenses at the local hospital,
building donated by the town hospital,
The state medical establishment has
which has cared for many uninsured
is still raising money to build a perma-
expressed concerns about insuring the
"What's needed is to increase the
patients. Steven A. Caywood, president
nent home. At that time organizers
continuing competence and medical
number of people providing primary
and chief operating officer of the Hilton
plan to be more aggressive in market-
currency of the aging staff, many of
care without cutting our noses off," Dr.
Head Hospital, said it cost his emer-
ing the free medical care. Already,
whom were trained decades ago. But
McConnell said. "It would be a pity to
gency room more than 20 times as
there is interest from other states. Offi-
supporters of the center say the poten-
solve our problem by destroying the
much as Dr. McConnell's clinic to treat
cials at Catholic Charities and St. Pe-
tial problems are insignificant com-
most advanced health care system in
a developing case of pneumonia. "The
ter's Medical Center, a 416-bed com-
pared with the benefits.
the world, the envy of the world, when,
person isn't going to get out of here
munity teaching hospital in New
"This is fantastic and very much
at a very modest cost, you can create a
without a couple hundred dollars in
Brunswick, N.J., say they are develop-
needed," said Thomas Barnwell Jr., a
pool of physicians practicing for free.
tests," Mr. Caywood said.
ing plans for a similar clinic in central
third-generation native of Hilton Head
And best of all, you haven't tinkered
Dr. Paul Long, an internist who has
New Jersey.
and community organizer who is build-
with our strengths and you've kept the
practiced on the island for 18 years,
Dr. McConnell acknowledges that,
ing low-income housing. "It's going to
government out of health care."
said that he had been a skeptic, like the
unlike this seaside resort, many areas
be the glue of this community. It's
Dr. McConnell notes that about
rest of the local medical community,
of the country do not have enough
going to bring people together, bind
120,000 doctors retire every year, about
but that he was now an ardent support-
retired medical people to run a full-
them together and glue them together
the same number of students that an-
er.
service clinic. But he said that even a
like nothing before.'
NYNEX
300 East Washington Street. Syracuse, NY 13202
Tel 315 477.1967
Stephen G. McDermott
Vice President and General Manager
NYNEX
April 8, 1994
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500
Dear Mrs. Clinton,
It was a pleasure to be at Syracuse University as part of the audience
for the demonstration of telemedicine you participated in and to hear you
speak afterwards. Like you, I am amazed at the technology that allows
doctors to share medical images, data and video-communications. Even
more amazing is the fact that the technology is here today and yet the vast
majority of Americans don't have access to it because of Laws and
regulations that are ten years out of date.
I am encouraged by the Clinton Administration's support of the
concept of the Information Superhighway. You saw it work. You know that
it can improve medical care while lowering costs. We find in the Markey-
Fields bill (H.R. 3636), and in the version of the Brooks-Dingell bill (H.R.
3626) that was recently voted out of the House Energy and Commerce
Committee, the policy which will encourage the Regional Bell Operating
Companies to build the superhighway. Taxpayers should not have to fund
a project that industry is willing to tackle.
In the Hollings bill (S. 1822) we have public policy which, in fact, will
delay the advent of the superhighway by discouraging RBOC infrastructure
investment within their home market areas. This can only hurt the national
and local economies.
NYNEX Recycles
2
Thank you for visiting Syracuse and taking the time to see this
revolutionary collaboration between Syracuse University, NYNEX
Corporation and the other NYNET participants. Please feel free to contact
NYNEX for further demonstrations of the new telecommunications
technology.
Sincerely,
cc: Mr. Moynihan
NYNEX
300 East Washington Street, Syracuse. NY 13202
Tel 315 477 1967
Stephen G. McDermott
Vice President and General Manager
NYNEX
April 8, 1994
The Honorable Patrick J. Moynihan
The United States Senate
464 Senate Russell Office Building
Washington, D.C. 20510
Dear Senator Moynihan:
It was a pleasure to be with you at Syracuse University for a
demonstration of telemedicine. The technology that allows doctors to
share medical images, data and video communications is amazing. Even
more amazing is the fact that the technology is here today and yet the vast
majority of Americans don't have access to it because of laws and
regulations that are ten years out of date.
I am encouraged at how the concept of the Information
Superhighway has captured the national imagination. You saw it work.
You know that it can improve medical care while lowering costs. We find in
the Markey-Fields bill (H.R. 3636), and in the version of the Brooks-Dingell
bill (H.R. 3626) that was recently voted out of the House Energy and
Commerce Committee, the policy which will encourage the Regional Bell
Operating Companies (RBOC's) to build the superhighway. Taxpayers
should not have to fund a project that industry is willing to tackle.
In the Hollings bill (S.1822) we have public policy which, in fact, will
delay the advent of the superhighway by discouraging RBOC infrastructure
investment within their home market areas. This can only hurt the national
and local economics.
Thank you for engineering Mrs. Clinton's visit to Syracuse and taking
the time to see this revolutionary collaboration between Syracuse
University, NYNEX Corporation and the other NYNet participants. I am
hopeful of the opportunity to meet with you and Morgan Kennedy, of
NYNEX's Government Relations group, to further demonstrate how the
NYNet project can serve New York's economy.
It has the potential to make both our service and manufacturing sectors
much more competitive with other states and nations. Morgan will call your
office to try to arrange a further demonstration of this remarkable
technology.
Sincerely,
air Charles
cc: Hillary Clinton
THE WHITE HOUSE
WASHINGTON
December 2, 1994
Ms. Abbey S. Meyers
National Organization for
Rare Disorders
100 Route 37
P.O. Box 8923
New Fairfield, CT 06812-8923
Dear Ms. Meyers:
Thank you for writing to share your ongoing support for
health care reform and for your outstanding efforts to help
Americans with rare "orphan diseases." Your educational,
research, networking and advocacy programs are an invaluable
part of ensuring access to high quality health care for the
more than twenty million Americans living with rare disorders.
As you know, Congress was unable to pass health care
legislation this year. Well-financed special interests have
fought for sixty years to prevent health care reform and, over
the past year, have waged an unprecedented battle. And yet,
because of the will of the President, the courage of some
members of Congress and the support of people like you, we have
put health reform on the national agenda and begun a thought-
ful discussion about how to reform our health care system.
Thank you again for writing on behalf of people with rare
disorders. The President and I hope that we may continue to
count on your support when we return next year to fight for
meaningful health care reform.
Sincerely yours,
Hillary Rodham Clinton
VIP
LeFF
Thoene, M.D
National Organization for Rare Disorders, Inc.
resident:
Abbey S. Meyers
NORD
100 Rt. 37, P.O. Box 8923
New Fairfield, CT 06812-8923
Member Organizations:
Alliance of Genetic Support Groups
(203) 746-6518
FAX (203) 746-6481
TDD (203) 746-6927
Alpha, Antitrypsin Deficiency National
Association
ALS Association
Amencan Brain Tumor Association
American Porphyria Foundation
American Society of Adults with Pseudo-
Obstruction. Inc (ASAP)
Amencan Syringomyelia Alliance
September 30, 1994
out of the darkness,
Project, Inc.
Into the light
Aplastic Anemia Foundation of America
Association for Glycogen Storage Disease
Batten Disease Support & Research
Association
Benign Essential Blepharospasm
Research Foundation. Inc
Carpal Tunnel Syndrome/RSI Association
Charcot-Marie-Tooth Association
Chromosome 18 Registry and Research
Mrs. Hillary Rodham Clinton
Society
Comelia de Lange Syndrome
The White House
Foundation Inc
Cystinosis Foundation, Inc.
Dysautonomia Foundation, Inc
1600 Pennsylvania Avenue
Dystonia Medical Research Foundation
Dystrophic Epidermolysis Bullosa
Research Assoc (D.E.B.R A.)
Washington, DC 20503
Ehlers-Danlos National Foundation
Epilepsy Foundation of Amenca
Families of Spinal Muscular Atrophy
Fanconi Anemia Research Fund. Inc.
Foundation for Ichthyosis &
Dear Mrs. Clinton:
Related Skin Types, Inc (F IR.S
Guillain-Barre Syndrome Foundation
International
Hemochromatosis Research
Foundation. Inc.
On behalf of twenty million Americans with rare "orphan diseases," I want to thank you
Hereditary Disease Foundation
Histiocytosis Association of America
for all your work and effort for health care reform. A few months ago, when I stood
Human Growth Foundation
Huntington's Disease Society
of Amenca, Inc
with you on the stage of the Humphrey Building with other members of the National
Immune Deficiency Foundation
Inclusion Body Myositis Association
International Fibrodysplasia Ossificans
Health Council, I was proud that you were leading the reform effort and grateful that
Progressiva (F O.P.) Assoc., Inc.
International Joseph Diseases
the President had focused the nation's conscience on the needless human suffering
Foundation Inc.
International Rett Syndrome Association
Interstibal Cystris Association
caused by our current inequitable health system. We are profoundly saddened that
of Amenca, Inc
Lowe's Syndrome Association
Congress failed to come to a consensus.
Malignant Hyperthermia Association
of the United States
Meniere's Network (EAR Foundation)
Myasthenia Gravis Foundation
Myeloproliferative Disease Center
When Senator Mitchell announced that health care reform was dead, he wrote the
Narcolepsy Network, Inc
National Adrenal Diseases Foundation
National Alopecia Areata Foundation
obituary for thousands of Americans who will continue to have no access to health care
National Ataxia Foundation
National Chronic Fatigue Syndrome
and Fibromyalgia Association
until reform is enacted. People with pre-existing conditions, people with hereditary
National Foundation for Ectodermal
Dysplasias
diseases, people who cannot afford to pay for insurance are counting on you not to give
National Fragile X Foundation
National Leigh's Disease oundation
National Marfan Foundation
up, and to keep this issue at the top of the 1995 congressional agenda.
National Mucopolysaccharidoses
Society. Inc.
National Multiple Sclerosis Society
National Neurofibromatosis Foundation
National PKU News
We pledge our support and commitment to health care reform. We want you to know
National Retinitis Pigmentosa
Foundation Inc.
National Sjogren's Syndrome Association
that you can count on us next year, or for as many years as it takes to rebuild our health
National Spasmodic Torticollis
Association (NSTA)
care system.
National Tay-Sachs & Allied Diseases
Association. Inc.
National Tuberous Sclerosis
Association, Inc.
National Urea Cycle Disorders Foundation
National Vitiligo Foundation, Inc.
Neurofibromatosis, Inc
Obsessive Compulsive Foundation
Very truly yours,
Osteogenesis Imperfecta Foundation
Oxalosis and Hyperoxaluna Foundation
Paget Foundation
Parkinson's Disease Foundation, Inc.
PKR Foundation
Prader-Willi Syndrome Association
Reflex Sympathetic Dystrophy
Ms Abbey S. Meyers
Syndrome Association
Scleroderma Federation, Inc
Scleroderma Info Exchange. Inc.
President
Sickle Cell Disease Association of
America, Inc.
Sjogren's Syndrome Foundation Inc.
Tourette Syndrome Association Inc.
Tngeminal Neuralgia Association
ASM:aa
United Leukodystrophy Foundation Inc.
United Parkinson Foundation
United Patients' Association for Pulmonary
Hypertension, Inc
Vestibular Disorders Association
VHL Family Alliance
Wegener's Granulomatosis Support Group, Inc
Williams Syndrome Association
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Associate Members
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Charcol-Marie Tooth International
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Chapter
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DC. VA
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HHT Foundation International Inc.
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Assoc Inc.
JCM Resource Center
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Sarcoldosis Research Institute
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Congential Adrenal Hyperplasia Support
Just for the Kids of NPC Inc.
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Assoc Inc (CAHSA)
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National Cushings Association
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West Central Head Start
Russell-Silver Syndrome Inc
Earl J. Goldberg Aplestic Anemia
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Parent to Parent of GA, Inc.
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'Associations are joining continuously. For
Palsy. Inc.
newest listing. please contact the
NORD office
Dedicated to Helping People with Orphan Diseases
6/94
NOV- 2-94 WED 17:25
P.01
Nations! Organization for
100 RT 37. PO BOX 8923
Rare Disorders (NORD)
NEW FAIRFIELD. CT 06812-8923
S
of
Date:
11/2/94
FAX
Number of pages including cover sheet:
1
From:
To: Jesselyn Brown
NORD
Phone:
Phone:
(203) 746-6518
Fax phone:
Fax phone:
(203) 746-6481
CC:
REMARKS:
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For your review
Reply ASAP
Please comment
Parkinsons liver Foundation, Inc
I
Re ORGANIZATIONS:
PKH
Alliance (( Genetic Surgert imuns
out of the darkness,
Prader WIN Syndrome Association
Alpha, Antitrypsin Deficiency National
Reflex Sympathetic Dystophy Systeme km.
Association
Selenderm Federation, In:
into the light
NS Association
Merican Brain Tumer desociation
Sclemderma Info Exchange Inc.
American Peoplepria Foundation
Sickle Cell livease Association of America, Inc.
American Society of Mults with Prudo-
Speren's Syndmome Faucalation, Inc
Obstruction, Inc. (ASAP)
Tours : Systome Association, Inc.
American Springora,elia Illiance Project. Inc.
Trigeminal Newsige Association
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limbed Partinan Ecumission
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lined Parients Association fur Pulmonary
Benign Exential Elepharasyasm Research
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Foundsting Inc.
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WIL. timily Allance
Issocation
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NORD
NORD*
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Pen Foundation
What Is NORD"?
ission Statement
The National Organization for Rare Disorders
(NORD) is the federation of voluntary health
organizations dedicated to helping people with
rare "orphan" diseases and assisting the organi-
. zations that serve them. NORD is committed to
=
the identification, treatment, and cure of rare
disorders through programs of education,
advocacy; research, and service
ORD-The Beginning
Begun in 1983. NORD was an outgrowth of a
unified effort by rare disease support groups who
were determined to solve the "orphan drug"
dilemma. Treatments for these disorders were not
being developed by the pharmaceutical industry
because they were "drugs of limited commercial
value." Consequently, voluntary health agencies
and support groups banded together to urge
passage of federal legislation that would en-
courage pharmaceutical companies to develop
"orphan drugs." In 1983, when the Orphan
Drug Act was enacted, NORD formalized into a
national non-profit health agency dedicated In
the welfare of those with rare disorders.
ome Facts
Each rare disorder affects fever than 200,000
people in the United States.
There are more than 5,000 orphan diseases
affecting some 20 million Americans. One out
of every 12 people suffers from a rare disorder.
NORD is unique. 11 is the only organization of
its kind - a federation of more than 135 not-for-
profit health organizations, and thousands of
individuals and medical professionals-serving
people with rare disorders throughout the world
P.03
NORD Programs and Services
NORD's Medication Assistance Programs
NORD's newsletter, Orphan Disease Update,
Yes, I do wa
provide several free prescription drugs to needy
is published three times annually. This newsletter
diseases. M
patients who cannot afford treatments.
is mailed to thousands of people throughout
NORD's prog
ducation
and services
the world.
NORD's primary program is education of the
nformation & Referral
NORD publishes the Physicians' Guide to
Membershi
public and medical professionals. NORD is a
NORD provides information to medical profes-
Rure Diseases. This book enables physicians to
Con
worldwide clearinghouse for information about
sionals, libraries, educators, corporations and
find accurate and timely diagnostic information.
orphan diseases, answering more than 75,000
Frie
individuals. NORD refers patients and families
One out of three individuals with a rare disease
inquiries each year from throughout the world.
to appropriate sources of assistance and support.
Basi
does not receive a correct diagnosis for up to five
The rare disease information is written in simple.
(min
When patients are needed for clinical triais, we
years, and one out of six wait more than six years.
understandable language SO that patients and
refer them to the researchers through NORD's
1 car
families can understand it NORD's information
Sponsorship of an Annual Patient/Family
but
confidential patient registry: NORD can usually
is also made available to the public through
Conference, which is aimed at providing help to
locate patients with even the rarest diagnoses.
Plea
OUR Rare Disease Database (RDB) which is
patients and families who must cope with the
to in
available on the CompuServe electronic
upport Groups and Advocacy
impact of living with a rare disease. Information,
Che
information system.
networking opportunities and creating an envi-
NORD provides technical assistance to
ronment of hope are the principal goals. NORD
The NORD literature order form lists more
support groups, helping them to start and grow
also convenes an Annual Membership Conference
Name:
than 1,000 rare disorder entries from NORD's
with minimal waste of precious resources.
providing training and technical assistance
Rare Disease Database.
NORD monitors implementation of the
Address:
to leaders of support groups and voluntary
NORD's book. Physicians' Guide to Rare
Omhan Daw SCT and advocates for increased
health agencies.
Diseases, is a printed version of the database
City:
government funding of medical research. NORD
written in technical terminology for medical
participates in efforts to assure that people with
ORD Membership and Support
Daytime Phi
professionals.
disabilities maintain the rights and services
NORD is reliant OR membership and charitable
they deserve.
esearch
contributions to continue providing its programs
Please det
contributic
NORD is an advocate for the interests of all
oi education, advocacy, research and services to
Besides advocating for increased government
Nation:
people with orphan diseases, helping to assure that
people with rare disorders. NORD spends your
research funds, and referring patients to clinical
PO Box
government programs and services are available
contribution dollars wisely; less than 15 cents
trials and genetic investigators, NORD funds
Phone:
and accessible to patients and families.
of every dollar donated to NORD is spent on
grants on new treatments for rare diseases. Clin-
fundraising and administration.
A copy of I
ical research has historically been underfunded,
he NORD Story-Who Is Helped
obtained b
and NORD attempts to fill this void, creating
Your membership in NORD will insure that you
More than 75,000 people contact NORD
New Y,
hope for millions whose disorders are presently
continue to receive the NORD newslever, Orphan
directly each year for information and help.
Albany
hopeless and untreatable.
Disease Update, which reports on:
More than 210,000 people access NORD's
Progress in research on rare disorders.
If you prete
amily Programs
Rare Disease Database (RDB) each year through
CompuServe or on touch-screen computers in
Recent government, health-related industries
pharmacies and medical waiting rooms.
and scientific community activities.
Charge
NOV- 2-94 WED 17:26
NORD's "Networking Program" puts
families with the same diagnosis in touch with
(Minin
each other. This helps people find mutual
Through NORD's Networking Program more
Personal accounts of courageous struggles by
people with orphan diseases.
Card
support and encourages the formation of new
than 7,000 families are linked to other families
voluntary health agencies for specific diseases.
each year who have similar disorders.
More than 4,000 financially needy individuals
Name
NORD's Patient Services Program provides
counseling and advice to people seeking help
are provided critical, life-saving drug therapies
Signat
with accessing social services and learning about
through NORD's Medication Assistance Program
Daytin
appropriate programs for people with disabilities.
each year
it to i
in the effort to help conquer rare
membership/contribution will help continue
ams of education, research, advocacy
"
11 Dues (Make checks payable to NORD)
ributing
$100
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$ 50
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$ 25
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se send me information on thoughtful ways
clude NORD in my will
:k Or Money Order Enclosed
State:
Zip:
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to:
I Organization for Rare Disorders (NORD)
8923 . New Fairfield, CT 06812-8923
203) 746-6518
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1 writing to:
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to use your charge card. fill in bax below:
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THE
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Phone
H- INSURANCE H- INSU RANCE
THE WHITE HOUSE
August 22, 1994
Ms. Carol Mollner
Executive Director
National Network of Women's Funds
1821 University Avenue
Suite 409 North
St. Paul, MN 55104
Dear Ms. Mollner:
Thank you for sending the letters from
Minnesota Comprehensive Health Association
(MCHA) policyholders that I asked about
when we met.
The proposed premium rate increases
described in the letters demonstrate why we
so desperately need real health care
reform. The President wants to guarantee
private health insurance to all American
families. Without universal coverage, the
poor will continue to receive health care
through government programs and the wealthy
will continue to be able to afford to
purchase coverage, while the middle class
will remain at risk. Twenty-four million
Americans, most of whom work hard to earn a
living, will have no insurance at all, and
one million will lose coverage each month.
And without universal coverage, cost
shifting and the need of individuals
without insurance to rely on costly
emergency care will persist, causing health
care costs to continue to skyrocket.
Ms. Carol Mollner
August 22, 1994
Page 2
As you noted in your letter, MCHA
groups individuals and families together to
purchase health insurance. However,
because MCHA is a risk pool only for
Minnesotans turned down by other health
insurers -- mainly because they have so-
called "pre-existing conditions" -- premium
rates for MCHA policy holders continue to
increase. The health reform bills intro-
duced by Senator Mitchell and Congressman
Gephardt will give small businesses and
families the opportunity to band together
to buy insurance. In contrast to MCHA,
however, the bills will allow all people --
the healthy and the sick, the young and the
old -- to join voluntary purchasing
cooperatives to bargain for and purchase
health insurance on the same basis as large
employers. No longer will small businesses
and individuals pay as much as 35 percent
more than big businesses for the same
health insurance.
Thank you again for your letter. I
appreciate your support and your valuable
work on health care reform.
Sincerely yours,
Hillary Rodham Clinton
NNF
NATIONAL NETWORK OF
Women's Funds
1821 University Avenue Suite 409 North St. Paul, MN 55104
(612) 641-0742
(612) 647-1401 FAX
April 22, 1994
Hillary Rodham Clinton
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
During the reception at the White House for the nonprofit sector on Tuesday, April 12, 1994,
I told you about the letters that I had just read from policyholders concerned about premium
rate increases proposed for the Minnesota Comprehensive Health Association. You asked me
to send copies of some of the letters.
The Minnesota Comprehensive Health Association (MCHA) is the state's risk pool for
Minnesotans who have been denied individual insurance coverage in the private market due to
preexisting conditions. I am an MCHA policyholder, and a public/policyholder appointee to
the MCHA board of directors.
MCHA is funded solely through enrollee premiums (which by law are required to be between
101% and 125% of the weighted average of rates charged by health carriers selling
individual policies of health or accident coverage), and by an annual assessment on insurance
companies, HMO's, Blue Cross and Blue Shield of Minnesota and fraternal organizations
selling health or accident insurance in Minnesota. Because of ERISA law, self-insured health
benefit plans do not contribute to MCHA.
Currently (2/94), 35,272 people have health insurance through MCHA. Over half live outside
of the metropolitan Twin Cities area. Two recent studies of the MCHA population provide
other demographic data about policyholders. The majority of MCHA policyholders are self-
employed; a greater number are unemployed than in the general population; household
income is significantly lower than the median household income for all Minnesotans; and
about 83% of policyholders pay their entire premium. Only approximately 25% of the
enrollees had medical costs that exceeded their annual deductibles (of either $500 or $1,000),
and one percent (1%) of enrollees accounted for 30% of the plan's total billed charges.
About 25% of the plan disenrolls annually (most finding other insurance); for the others,
MCHA remains the only current option for health insurance.
MCHA adjusts its rates annually, effective July 1. Proposed rates must be distributed to
policyholders for public comment. The attached sheet shows rates proposed for 1994, as well
as the current rates which went into effect July 1, 1993. In almost all age categories, the
proposed rates are at the maximum allowed by law. The enclosed letters were written to
express concern about these proposed rates. If these rates are approved, they will increase the
burden for many policyholders who are now barely able to pay their premiums. Some will be
forced to pay as much as one third to two thirds of their income for health insurance. As
these letters indicate and as you know so well, people are faced with impossible choices:
paying for health care or for other necessities. Many talk about cutting back on medications
because they can't afford the cost, and some may give up health insurance altogether;
particularly bad options for people who have conditions which require health care.
Each year, I have read the many letters and attended some of the public meetings that MCHA
holds to provide policyholders an opportunity to comment on the rates. Most of the
policyholders are quite knowledgeable about health care costs; they attempt to review hospital
and physician charges for overcharges and duplicate bills; they shop carefully for the best
prices on medications and health care services. They also speak about the difficulties they
have in paying the premiums, deductibles and co-pays; about their frustration with being
forced into a risk pool; and about their general frustration with the escalating costs in the
whole health care system.
I hope that these letters will be helpful to you and your staff in your efforts to secure
meaningful health care reform. If you would like further information about MCHA or the
concerns of its policyholders, I would be pleased to provide it.
Next week, my organization, the National Network of Women's Funds, will be holding a
national conference in New York City on women's health care issues. The focus of the
conference is on health care reform, and its impact for women. Women's Health: From a
Privilege to a Right -- A Platform for Change is designed to educate women's foundations
and other philanthropists about the importance of educating their own constituents about the
stakes involved in the health care reform debate, and supporting grassroots organizing to
assure that health care reform benefits all Americans.
Thank you for the leadership you and President Clinton are providing to achieve health care
reform in the United States. Because of the work that you are doing, we have the opportunity
to make quality, affordable health care available to all.
Sincerely,
Coese Mollner
Carol Mollner
Executive Director
LETTERS FROM POLICYHOLDERS
REGARDING 1994 PROPOSED PREMIUM RATE INCREASES IN
THE MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION
Proposed MCHA Quarterly Rates
Effective date: July 1, 1994
Plan 1 and Plan 2
Plan 1
Plan 2
$1,000 Deductible
$500 Deductible
Quarterly
Quarterly
Percent of
Quarterly
Quarterly
Percent of
Rates
Rates
Increase
Rates
Rates
Increase
Effective
Proposed
(Decrease)
Effective
Proposed
(Decrease)
Age
7/1/93
7/1/94
7/1/94
7/1/93
7/1/94
7/1/94
=< 14
$178.86
$196.38
9.8 %
$229.44
$257.07
12.0%
15-29
$182.31
$196.38
7.7%
$261.30
$257.07
(1.6)%
30-34
$205.29
$220.32
7.3 %
$282.09
$288.39
2.2 %
35-39
$231.30
$242.94
5.0 %
$319.89
$318.00
(0.6)%
40-44
$272.34
$267.27
(1.9)%
$353.46
$349.86
(1.0)%
45-49
$320.94
$311.88
(2.8)%
$410.88
$408.24
(0.6)%
50-54
$370.83
$383.43
3.4 %
$473.94
$501.90
5.9 %
55-59
$430.17
$472.02
9.7 %
$548.13
$617.88
12.7 %
60-64
$514.41
$540.39
5.1 %
$654.66
$707.37
8.1%
- 65 +
$585.39
$589.14
0.6 %
$765.75
$771.21
0.7 %
Dependent Children
1 Child
$178.86
$165.84
(7.3)%
$229.44
$217.08
(5.4)%
2 or more Children
$244.02
$307.08
25.8 %
$342.93
$401.97
17.2 %
Medicare Plans
Quarterly
Quarterly
Percent of
Rates
Rates
Increase
Policy Form
Effective
Proposed
(Decrease)
Number
7/1/93
7/1/94
7/1/94
1. Extended Basic Medicare Supplement
F4495
$502.02
$582.66
16.1%
2. Basic Medicare Supplement
F4494
$130.11
$152.13
Part A Deductible Rider
F4561
$58.80
$59.88
Part B Deductible Rider
F4562
$21.00
$26.97
Additional Part B Rider for 80% of U & C
F4638
$89.52
$22.44
The second plan for Medicare Supplement benefits is offered as a Basic Medicare Supplement contract
with 3 optional riders. This contract and any of the optional rider combinations result in the following
total package rates for the 7 possible combinations.
Basic Medicare Supplement-nodry-leme
$130.11
$152.13
16.9%
Basic & Part A Deductible Rider
$188.91
$212.01
12.2 %
Basic & Part B Deductible Rider
$151.11
$179.10
18.5%
Basic & Part A & B Deductible Riders
$209.91
$238.98
13.8%
Basic & Part A & B Deductible Riders & the Rider for 80% of U & I
$299.43
$261.42
(12.7)%
Other Option Combinations
Basic & Part A Deductible Rider & the Rider for 80% of U & C
$278.43
$234.45
(15.8)%
Basic & Part B Deductible Rider & the Rider for 80% of U & C
$240.63
$201.54
(16.2)%
Basic & the Rider for 80% of U & C
$219.63
$174.57
(20.5)%
15-Mar-94
April 11, 1994
Ms. Lynn Gruber, Executive Director
Minnesota Comprehensive Health Association
5775 Wayzata Boulevard, Suite 910
St. Louis Park, Minnesota
55416
RE: MCHA Proposed Premium Increase for Children in 1994
Dear Lynn:
I am writing to you once again to share our deep-seated concern about the
proposed 1994 premium rate increase you are requesting for the children
involved in the MCHA program. Although you indicated that the "average"
proposed rate increase is 4.7%, the increase for children of 17.2% to 25.8%
(Note: this is 3 to 5+ times the average increase) is excessive and
outrageous. I ask you in your Board meeting to reduce the amount of premium
increase you are requesting for the children involved in the MCHA program.
Because we have always had the rights of children foremost in our minds here
in Minnesota, I find it contradictory that the Board of MCHA would choose to
impose such a harsh penalty upon the children covered by its plans. I realize
that out of the 35,500 individuals covered by the plans, very few are single
children, and even fewer are multiple children within one family. Our
collective voice isn't very large but it is a clear one.
I have attended each of the yearly rate review meetings, and have politely
asked if the Board was aware of this effect upon the children's rate, and if their
originally proposed rate increases ranging from 19% to 62.8% were considered
to be "reasonable". I am pleased to say that both the MCHA Board and the
Commissioner have been approachable about this issue after I raised their
level of awareness, and reduced the final percentage increases to a high but
more equitable amount.
2 - J. Gunville
4/11/94
This year, the MCHA Board has requested a 17.2% increase in our children's
premium in the MCHA2 program and an unbelievable 25.8% for the children
on Plan 1! It just doesn't seem fair
or reasonable. I expressed our concerns
at the meeting held at the Holiday Inn - Metrodome on Friday, March 25th.
Because our entire family of 5 is forced to be in MCHA, we as a family face
individual deductibles that initially total $2,500.00 per year, plus the current
yearly premium of almost $4,500.00 (and whatever yearly increase is assigned
as a result of this process), along with additional co-pay and non-covered
expenses. To put it bluntly, the cost is unbelievable. Our other living needs
must always be placed secondary to the overall cost of providing this minimum
safety-net coverage.
We ask for your understanding and compassion in revising downward the
proposed premium rate increases for children in the MCHA program In a
related issue that I have previously brought to the Board's attention, I also ask
you to actively modify the MCHA healthcare program to resolve the inequity
within the "individual deductible" penalty for family units. I would like you to
consider recommending an aggregate deductible of at most three (3) times the
base deductible for MCHA families.
We appreciate your concern and your consideration.
Sincerely,
CC:
Commissioner James Ulland
Minnesota Department of Commerce
133 East Seventh St.
St. Paul, Minnesota
55101
TOTAL P.03
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P5 Release would disclose confidential advice between the President
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P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
8 Lynn Gruber
mossmn april 6. 9.4
Dear Lynn This in regards to your Propased ms H.A
Premium n Creased Rate of Julyl 94
I'm 86 yrs old and very ill I Cannet attend the meeting
of irst of all Im having trauble finding a good E's on This
meHA. Good hirs dont wantit. Right man Sn ith cut a
and and 2 need 9 Dr. young E'rs dont of new hase to take Care
of old peagle.
Zhisis W g and Ins. Ins never hadto Pay any hing more
than a here dollars
on tresday aprils I tried to reach you. I lauldnt.
2 did talk to Wianne Tenant. I told her I need a Dr
in daws tawn mpls, + he list given wut by medicare Seated
all Wrs on f. Lis are ant in Subscribe
2m Strugling to peep This Ins. I cant 87 and a large
raise Such as in yusis notice of 582.66 from 50202
my Present Premium ) Lists an an increase of 8064 2f
was in creased from 475.98 to $ 50202 July 1 my Only
in come is social Security ity. 19520 5040 rets Pension
hand you
0039
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4/7/94
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COLLECTION:
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First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
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of gift.
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
received
4/11/94
4- 7-1994
Lynn R. Gruber
Mr. Comprehensive Health Assoc.
Blue Shield costing 321.99 a quarter
Thankfully & got a health
5775 Wayzata Blud.
Suite 910
policy Devith MCHA for 51441
St. Louis Park, Mr. 55416
a quarter If these MCHA's
not sure how long we aer keep
proposed rates go into effect, I'm
Sreetings,
I am writing you concerning my
paying my health insurance I'm
health insurance Desse to some health
61 years of age & believe & can't
problems, my Blue Cross Blue shield
get medicare for some years.
Hoping that you can apply
policy went up to $100 a quarter with
some pressure to keep the rates
come exclusions
where they are now, & am
My hubband is nearly 70 your
old with a bad knee to cant work
Signerely yours,
anymore. He received Social security
in the amount of $ 4, 224. We also
received a rent amount of 6, 750 ok
0036
(9)(q)
other small incomes but this is the
80 acres of land We have a few
majority of our income.
My husband has a very good
insurance policy with Blue Carsa
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Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003c. letter
From: Policyholder, To: Commissioner Ullaud [partial] (1 page)
4/11/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA|
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Jymn
We Sent This to
4/11/94
d
Com Ullord. also sending
yowa capy.
more
Dear Commissioner ulland:
I am writting about The proposed rate increase minnesate
its policy holders.
Comprehensive Health association insurance is considering for
my Extended Basic medicare Supplement would roise
from 502.02 to 582.66 a quarter, an increase of 16.1% Very
shaking to a retired person on a fixed income, also the real-
ization this is only for mad) use. my wife too must pay for a
health Care supplement This cirtainly points to a need for
universal health insurance. We, who have health problems know
we cannot depend or prevate insurance to Care about the indured.
We attended the public meeting MCHA had at Rednord talls.
Every mcHA policy holder was paying for his own insurance Several
members said Their savings would soon be depleted and they
would need government assistance, most of their income went to
health insurance: Other policy holders were close to the same pre-
dectument, either drop Their health insurance and cease to get
needed health Come cr continue to dip into their savings: Theyfeel
disparate and abordoned
This has become a very sevious problem to the senior citizen
or these forced to return early because of their health. I hope There is still
some compossion in over government leaders to hald back The rapid
esculation in misissance premiums. Thank you.
(b)(6)
003C
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DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003d. letter
From: Policyholder, To: Those considering premium increases
3/26/94
b(6)
[partial] (2 pages)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA|
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRAJ
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
h(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Bloomington, MN 5543
march 26, 1994
IN. comprehensive Health assoc,
MAH SERVICES
St. Paul, MN. 55164
(b)(6)
Custom 2,8,1994 8
003d
MAR 28 1994
To those considering premium increases,
I was unable to attend your public meeting, but
wish to have my voice heard. I am a widow
of 57 years of age. I'm living on a fixed income Its
be able to care for grandehildren my son-in-law
has been denied health insurance for O. lengthy per
following the removale of a concerous testicle. my
daughter must work full time to get family coulray
nobody can give children the love they need K.
start life like their own families, if they are
sound ones. However, this isn't financially
rewarding to me!
l have been denied individual( private) insurance
due to a pre exhisting condition. I've turned in litt
in bills to MCHA but paid $1,720 in yearly
premiums with a $1,000 deductible. I'm terrified
to go to doctors or of getting ill. The propose
hike would mean for me - $ 1,888 in basic
premiums without any drugs or return to me,
Then without any choice or options I have $1,000
deductible on top 8 this and must spend
about $ 3,000.00 yearly to receive any return.
That is about 1/6 th f my income at present
and rising
must all americans have to "throw this
children to the dogs in order to survive the
economic pressures, especially in healthcare N.
These increased come on top of people who are
already thurting HAM and abviously not covered by
employers.
It's hard to see the justification of nearly
10% increase in a period 8 1.9% inflation
The appearance would sum to be of taking
advantage where change for law permits.
The policy I currently have with MCHA
is poor compared to a previous preferred- one
solicy my gynecalogical visit used to be
covered, but I got nothing from MCHA
including a reduction for using a MCHA provider
This is a sad situation for me and
getting much worse as it is for many
hurting families. Please do not raise
rates as proposed! I have no options!
Sincerely,
003d
(b)(6)
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Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003e. letter
From: Policyholder, To: Minnesota Comprehensive Health
4/4/94
b(6)
Association [partial] (1 page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act [44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute {(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
MEMBERSHIP
SUPPORT
APR 0 4 1994
to: Minnesota Comprehensive Health are
the premium rate increased I
I am writing in regards to
roised sury year. ? Home can we
right now. why do shing have to he
fel that our rater are plenty high
health, I have diabites I a heart
pay more if more-} myself have poor
problem. But am found to work
in service premiums. this MCIA
full time to pay for mide unia t
is for people like me that have mi
choice as no one else will exception
on account four health conditions
I guess if me can't afford to pay it use
others who dn't try I ful we are
will have to go on wilfare like ND many
discriminated against with these high
pre run w. I have always trid
hard to pay my way I hope you
will recordeder
MAIL SERVICES
p.u.j #
lively JPR 47994
sroup #
(b)(6)
ooze.
3/31/94
Lynn R. Gruber
received
4/9/94
Mixn. Comprehensive Health and
as & was Unable to drine to
Huluth Mr. for the meetings A
am appalled at the rate increase
again what percentage of people
actually use there health Insurance
but must carry it if by
Chance they do need medical
care Sametimes never!
what will happen when
hes Clintons health bill goes
in effect ? We should have a
reduction in Insurance premiums.
what is the difference in Mr. Camp
& Blue Cross- Blue Shield when
we pay more higher premiums
than Blue Crass does for its
participants
With the ever increasing rate
people under a 1000 per Month
income, will slowly have to
gine up health insurance
we who do not work
for various reasons in the
age (60065) - Can't find work,
law pay, no persions -
we have our other monthly
bills to pay and can't Reep
up with higher premiums
We the people who are over
the 325,00 Welface limit but
under a $1,000 Mth income, who
will no langer be able
to Reep paying the continuing
high premiums will slowly
wither and die -
Policy holder
MARCH 7, 1994
Commissioner JAMES WilAnd
MINNESOTA Dept st Commerce
133 E. 7th STREET
St. PAUL, MN 55101
DEAR Commission HLLAND.
I would Like to oppose the lARge 16 To RATE
INCREASE proposed by The MCIAA Board FOR The
Extended MEDICARE Supplement offered by MiNN.
Compa HEAlth Assu, FOR the Following REASONS!
I HAD my FIRST HEART ATTACK IN MARCH of 1971
AT the AGE of 42, ENding my CARCER AS A Commercial
P.I.T ANd having to Sell my Fixed base operation.
business IN Albert WEA IN 1972, I continued to
work IN Commission SAles, AS No Company would
hire me with A history it heart Problems I WAS
FORCED to guit working After Two more heart AHACKS
between 1973 + 1977, ANd my INSURANCE WAS
CANCeled.
I WAS covered by INSURANCE of my wite's
Employer AS A FAMILY Dependent until 1987 And
medicare SINCE 1979 AS A supplement, until
my wife LOST HER Job of 18½ YRS to A Company the
out of STATE. she worked FOR until
moving That took over the FABILITIES off. she
Company HAd BREAST CAUSER ANd WAS Laid
She is NOW Employd by A NURSING home
working Nignts IN ORDER to get INSURANCE
Benefits And AFTER NOONS IN previous Employers
offices IN ORDER to make Ends meet.
I HAD R HEART by PASS operation IN April
1986 And Atery by Py PASS to Less IN Sipi of
1986 - Cohon CANCER SURGURY in Sipt st 1987
ANd FOOT SURGURY FOR Morton is NeromA IN Feb
of 1992.
To keep my self mentally Alert I do Volunter
HELP to OUR Local Hospital ASSICIATION which I
STARTED doing IN 1978,
I HAVE sinted these FACTS to point out THAT
I, AS well AS MANY other people under MCHA
Medicare Supplements have Never had the HEAlth
Accumolate SAvings NOR FINACIAL INVEStments
to To use UPON Renching AGE 65, And ARE ENtiRely
AT the Mercy it the MCHA Board whose
Primary FOCUS is FINACIAL.
The LAST INCREASE in medicare payments
WAS 2.6 To Loss AN INCREASE IN medicare
Payments FOR 1994, The PAST years have
been About the SAME. There is NOWAY
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Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003f. letter
From: Policyholder, To: Commissioner Ullaud [partial] (1 page)
3/7/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
P1 National Security Classified Information [(a)(1) of the PRA|
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRAJ
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA|
RR. Document will be reviewed upon request.
we CAN CONTINUE to Live And PAY out 30% at
OUR TOTAL Low income ON HEAlth And
INSURANCE COSTS.
I Plead with you to use your FULL
Asthority IN Lowering these who RAtes to Help
The people of This state, have hAd wong
Term illnesses, have had INSURANCE CANCLED,
OR Denied,
Sincerly
003f
(b)(6)
R
E
531
MAR 3 199A MAIL SERVICES
march 22, 1994
Dear Sirs:
I am writing about the increase in
our insurance premiums & feel a 1670
increase is quite high.
Socal Security. We are both working a
Both my husband and & are receiving
little Last year sanly made 1000 as,
because of my disabilities. m any people,
on mc HA, Ray the premiums, without
the help of an employer, mast of their lines,
even when they were able to work.
we do not know what we would have dane
mc HA has been a good insurance for me.
without it. shane had mc HA since the
late 70's. We would probably had fried
for medical assistance
filed bankruptcy, since we were not eligible
Thank-you for Sincerely listening to me.
MEMBERSHIP
SUPPORT
5
MAR 31 1934
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DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003g. letter
From: Policyholder, To: Gentlemen [partial] (1 page)
3/31/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA|
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA|
RR. Document will be reviewed upon request.
MEMBERSHIP
SUPPORT
MAR 311994
Gentlemen:
to if l twice to buy
your insurance policy every morth thing lusly need,
has ben very good to m lack I would Their
me through my last
go in The 110. ssor
Id Las on welfore as I am
illnes
to 1792 my pernium
tos old & cripplid to hold
was 475-78 up form
down 12 job. Sho said
436.68 in 1991. the
those Holden yours VIIN
1993 I paid 502.02 and
giving to Se golden exit I'm all
now you are proposing
first a fights
On $80.00 Increase Dow
the time
That seem fore. Every
the estreem rise in the
priture now. I goint
Hop you have the
year it has gone up
about $30.
now look of my side.
insurance premium Imay
Iam on a find income
beable to do son- socialying
the 3.4% increase does
not even come close To
if you didn't need the 80.
the 180 increase you work
Your truly
has has gove up by 20 F
per gollon tak Real Estate 100/0-
town up over
provier are higher Inw
003g.
time Ip to the store.
(b)(6)
It will wey thing
Inced to lazy gree wf
as level 10% a more
MARCH 27, 1994
TO WHOM IT MAY CONCERN;
I AM WRITING TO YOU ABOUT THE PROPOSED MCHA PREMIUM INCREASES.
WE ARE A FAMILY OF FOUR THAT ARE ON MCHA. I HAVE ASTHMA AND
MY SON HAD FEBRILE SEIZURES WHEN HE WAS A BABY WHICH HE HAS
OUT GROWN. WE TRIED TO GET INSURANCE THROUGH OTHER COMPANIES
BUT AS YOU CAN GUESS THEY ALL TURNED US DOWN DUE TO PRE-EXISTING
CONDITIONS. I'M GRATEFUL THAT MCHA WAS AVAILABLE FOR US TO GO ON
SO THAT WE COULD HAVE HEALTH CARE COVERAGE. ITS BEEN A STRUGLE
AT TIMES TO PAY THE PREMIUMS AND EACH YEAR IT'S GETTING ALOT
HARDER. I UNDERSTAND THAT THERE NEEDS TO BE INCREASES BUT
WHEN I SAW THAT THE PROPOSED INCREASE FOR 2 OR MORE CHILDREN
WAS GOING TO BE AN 25.8% I WAS PRETTY SHOCKED! IF THIS HIGH OF
AN INCREASE GOES THROUGH I'M NOT SURE WHAT MY FAMILY WILL DO.
MAYBE ONE OF US WILL HAVE TO DROP OUT OF MCHA AND NOT HAVE ANY
INSURANCE COVERAGE. THE THOUGHT OF THAT SCARES ME. PLEASE HELP
US SO THAT THIS DOESN'T HAPPEN. IF THE PROPOSED INCREASES
GO THROUGH WE WOULD BE PAYING ABOUT $300.00 A YEAR MORE. THAT
MAY NOT SOUND LIKE MUCH TO SOME PEOPLE BUT ITS TOO MUCH FOR US.
PLEASE I ASK YOU TO TAKE ANOTHER LOOK AT THE 2 OR MORE CHILDREN
$1000 DED. RATE PROPOSAL AND SEE IF THERE IS ANY POSSIBLE
WAY YOU CAN FIND TO KEEP FROM RAISING THE PREMIUMS 25.8%.
I'M COUNTING ON YOU TO FIND A WAY SO THAT MY WHOLE FAMILY
CAN STAY ON THE PROGRAM.
THANK-YOU FOR LISTENING
61
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Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003h. letter
From: Policyholder, To: Ms. Gruber [partial] (1 page)
3/28/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA|
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA|
RR. Document will be reviewed upon request.
(b)(6)
003h
March 28, 1994
Ms Lynn Gruber
Ex Director
MCHA
Suite 910
5775 Wayzata Blvd.
St Louis Park, MN 55416
Dear Ms Gruber,
On March 21, 1994, I attended a., MCHA
meeting here in Rochester.
I learned that there is to be another
increase in our permiums.
I S.9.W several people crying.
Most of us are on fixed income, and
we are just being "strapped. 11 We have
no choice but to pay these premiums as
we must have health insurance.
Flease help to give us a break.
Sincerely,
(b)(6)
003h
4
MCHH
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DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003i. letter
From: Policyholder, To: Mr. Gruber [partial] (1 page)
3/20/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA|
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
3/20/94
Dear Mr. Gruber,
This is in regard to a proposed rate
increase by M.C.H.A.
We do not plan an illness, especially
a Chronic "pre existing "one such as
Parkensons'. It ic a desappointment to eec in our
retirement but we are not welling to give
into Medicaid yet Or is this the way
you want it for those with a debitatating
disease? - I do believe we must go to
a Universal health Care plan which we
all partcipate but equally.
Please, do not increase the rates
anymore, we do not fear death, tares
Cold as hunger but the insurance
companies we now fear Occ grondchillren
can never pay there premuims for healthcare
and we will do all in our power
to make sure something in done to
decrease the cost
Who can we trust any more ?-
003;
(b)(6)
MCHA +
received
3/16/94
Jimm Gruber-
Iam writing in regard to the
notice I usered about an
increase in priminns for
my scriptemental insurance.
50.2- a quarter
which is almosr impossible
forme to pay. any increase
will almou cirtainly cause
me to have to generap my
Coverage.
I am 71 yrs abd, a widon
in a for 20 yk
because of Md, I have had
cancer surgery,
heare failure. mytack are in
terrible condition, buss can't
afford th have them Riped. If
anything major would ye sonody
with my have I. don't know
what would happens.
Iam withing to you because I
would MM he able Ao qu to
the meating than you are
going to have in Rochistn
I am against any increase in
premams. & there cruy crosistance available
as this times to help pay
premiums?
Thank you
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DOCUMENT NO.
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003j. letter
From: Policyholder, To: Lynn Gruber [partial] (2 pages)
3/22/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
1-45
MEMBERSHIP
MAIL SERVICES
SUPPORT
MAR 231994
3-22-94
LYNN GRubet
IN Regard to your PRice
INCRease in 7-1-94
I Feel that you d. your &
athers that make these Changes
do NOY have Horrest people in
mind. $502.02 per Cy-, OVER
my medicare, that is way to
much, I Really doNY understand
were you people aRe Coming
FROM you are Supose to
a help to peaple, Not to
make a handship ON people.
what is america Coming to
FJeRYONE whents to Rum FOR
OFFICE when they CAN, but
NO body doesn't want to stand
up FOR their position,
Some clay IN the FUTURE
you twill understand then
(b)(6)
003;
IT will be Late, you will Look
back SAY I made a mistake
why Not CORRect Now.
you Realizo that poor peAple
aRe getting podrer
my Sc/F as an Exp. my
LS total deabled Couse of two state
Street, I have two heart attacks X
UN openable. OUR Sal: per me_
$1381 00 befor Bills, often all Bills
INS. BAS,Light most. B.11 ctc, what IS
1.0F4 $157 per Mo: to Buy GRIS
GAS for my CAR.
you tell me IN your OWN
words how you CAN Justika INS
PREMIUMS Such as theres, thought
MIN was tohelp US get Cheapen
Better INS. I have Lost FAith
IN all you, IN the tns. Co X
BUISSINGS
(b)(6)
003;
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DOCUMENT NO.
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003k. letter
From: Policyholder [partial] (1 page)
3/21/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
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Freedom of Information Act - 15 U.S.C. 552(b)|
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P2 Relating to the appointment to Federal office [(a)(2) of the PRA|
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P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
financial information [(a)(4) of the PRA|
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
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P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Rochester, Minnesota
March 21, 1994
Last night I attended a meeting of MCHA in Rochester.
I am writing with hope that something will be done
to stop the rising cost of health care, including the terrible
cost of medications.
Contrary to reports, most senior citizens are not rich
old people.
I am a widow, I am 70 years old and work at a Super
market as a cashier. I work to pay my medicare supplement
insurance. I pay every month, as I cannot pay by the quarter.
I now pay $167.34 a month - the proposed rate for my age
is up 16.1% to $582.66 a quarter, making the payment $194.22
a month. When you add in the almost $40.00 a month from
Social Security for medicare, I would be paying $234.22
a month plus 20% of my medications.
I have high blood pressure, which is under control
with Cardizem, and high cholesterol, which I inherited,
and is being helped with Mevacor - the mevacor is over $3.00
a pill - my 20% is $20.06 a month - the Cardizem is $51.25
for 100 pills, my cost is $10.05 - I also take prednisone,
but that is inexpensive, so far.
My Social Security is $696.00 a month - I : do not have
a pension, if the proposed raise in MCHA is accepted - I
would not have a great deal of money left a month. At 70
years of age I'm sure my working days are numbered. The
$167.34 that I pay every month is becoming hard to do.
With the cost of insurances and medications going higher
and higher - I'm afraid many senior citizens will have to
rely on Medicade - and that will cost Minnesota a lot of
money. Things are getting out of hand - I have the extended
basic - because what I need are medications.
Thank you.
Rochester, Minnesota
(b)(6)
003k
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DOCUMENT NO.
SUBJECT/TITLE
DATE
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0031. letter
From: Policyholder, To: Lynn B. Gruber [partial] (1 page)
3/28/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
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Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA|
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
3/28/94
(b)(6)
003L
Dear Lynn B. Gribin
I am writing in regards to the
proposed MCHA vated & think the
new proposed rater are autrogesent
L am disabled froma a Chronce Mneso,
my Social Sicinity chick are 700-00. to
H der 582.00; dr and still keys my able
you think L CAN manage have
pay of can 't !! & even beary your
up. 502800 Every year Sacral
kup don't ogr up. on.
E pay raising the rater, lent smakes our you
Security wonder if its worth going
(b)(6)
0.03L
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DOCUMENT NO.
SUBJECT/TITLE
DATE
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003m. letter
From: Policyholder, To: Lynn Gruber [partial] (1 page)
nd
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA|
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA|
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Lynn Druber:
I'm writing a complaint to The proposed
16% raise in M.CHA medicare suplement.
my reasons. my 55 Check monthly is
moinc =
352 and progosed raise would bring
$ 357
to
monthly premium almost put
Mohealth insur.
me in a. place unable to keep insurance
premi=
caverage Our assets are a little
$ 195
above medicaid guidelines, and &
want De avoid that I hesitate
to drug prescription coverage because
of the undrown.
Please help me to be able & keep
insurance Coderage as I was
recently unfairly rejected for
standard Blue Crass Slue Shield Coverage.
Thank you
003m m
(b)(6)
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DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003n. letter
From: Policyholder, To: Mrs. Lynn Gruber [partial] (2 pages)
3/26/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRAJ
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA|
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRAJ
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
To: mrs Lynn Juckes
3-26-94
MCHA Exercitive Rector
P.O BOX 64566
St Paul Mr 55164
003n
From.
(b)(6)
Subjet Letter in regard to the proposed MCH its Insurance Fexcacial
Premium of 16% rate Increase and Extended Rx
impact on ow Budgetand lives, (Medicate supplement
I was fortunate to be able to
the Holfday onn mehodome. mps.
attend your MCHA meeting held last mighs, 3/25/94 at
policipholder were given time express
you Meeting was very informative to triews The
and it was a great meeting.
I met most of your people r Secretar
2 Board of Directors people also Charles Fergusa
of the state Dept of Commerce. and drdespress
Juny vew to feelings on proposed increase,
S also was surprised pleasantly
surprised to find these people and yourself
are real people that do Care!
of MCHA (Pool) for m 4 the yrs - 23 we help,
my wefe has enjoyed Other the than sewere this
have and asked for any help in regard
as to goot aid post years to
she is now 65-and one medical
fenencial costs of he Parkenson decase past 23yrs
Increased home Property Tasks andel wetl 50
But now, the financial impact of
this very large increased 16% or 322. - yr
on ker MCAA medicare Supplaint Ins.
Things are now running pretty Thin!
Few Comments
a
This letter is about money. 1. How much
can yous make we worked ma lifetuned for 38 yrs -
never messing work, had b children, all other
college) now have 10 grandchildien and we
are retired 3 yrs now
b
There are two widespresd atttudes about Money.
I
Money 2 is Money No THING 15 Everything! ?
Both atitudes are wrong, 20 saythat can't money
say is money is as importantas other there In our CAN Case-
not importants pretentious ! and you
In areas where money Counts, no thing
TAKE ITS PLACE? that when were at-
C Retured Short 3yr Fixancial ago SOCIAL Summary- Security INCOME 1048.MO = 12,528 INcome =yr
(no other wages-as -as 2 am caretaker for coife)
1
Less I Medical Expenses Expenses : MCHA (outof INS. erem. Pocke r med, Paed Expenser cost presempt
y
Medical pens &
Both our Expense
Income.
our
8
LIUING Expenses.
water fewer you
2
House TAXES 2080
centest 350
Heat # Bur 1080
Telephone 300
Insurance 750
food 2400
Transportation 1350 dothny &
Net year operating
Shortfall
add another 322 Ancrease (B1327) year Loss
I am not complaining, our ferencial
setuations have been from over 100 of
en Outof Pocketexphses for Duigs for 23
increase Sts just medicare thet axother Extended supplement 32200 a Costs year
years for wife Parkinson #
plus 4100 ea myout medicare monthly us cats
and what saverings we have left.
or 492 - yr) puts more pressure on
We would appreciate your consideration the 16%
of and a lower would percenting be very grakful increase than ! 8% would
be more realisted If Possible
Thanks much
003n
(b)(6)
for Onn. at ecast p prescription fifteen Co, drug white feature- policys I (notall
P. when with looking at medicare Happenent talked policys
I know product!
Co talked TO
AARP Wash sellen about
was 80-20 prescription Blan Quote was 19975
I asked of they colday ofthis plan in man its
too expensive They do sell regular supplement Plans Basic.
med Vs. Centers Prog currently (80-20 Duy 145°°No 34.- Mo Senior diout
Health Partners w/10 copay
medica - $1,59,95 mo - Mo-
80-20 Drug
Owatonna, Mn.
March 23, 1994
DEar Ms Gruber,
I'm writing to you in regard to the card enclosed Group and
I.D. No. enclosed. I am unable to attend any of your meetings
as my wife works full time and I have a severe disability and
I can't go myself and also the meetings are to far away.
My wife doesn't have any insurance with her job as shes self
employed and I havn't been able to work for 21½ years. This
insurance keeps going up for both of us and we just hardly
can make it financially. The present rate is more than we
can handle and I don't see how we can pay any increase. The
coverage I have I need and if I could drop some I sure would.
I go to Mayo Clinic and they have dropped some of their
charges $100.00 a treatment and yet Medicare and your insurance
still don't cover it. I am after my drug store all the time
on the costs. If I try to get them to lower their prices they
say pills and medication if going up all the time. I got one
item at Wal Mart less than 1/2 price and they are going after
Wal Mart for cutting prices.
I would like some consideration as I have never tried to get
the premium lowered before but I just con't pay it anymore. So
I'm asking you to lower the premium but I have to have the same
coverage as before. My wife is soon 65 years old and should
slow down or quit her job as its a full time job taking care of
me as I'm paralayzed ,bedridden and in a wheelchair but she can't t
afford to quit as we have no retirement built up.
Is this new health care bill going to be à benefit or a
disadvantage to me? What do you think? I would appreciate
some help and consideration to this matter, also a reply from you.
Yours truly,
03-21-94
Mrs Comprehensive Health Association
P.O. BOY 64566
ST PAUL MN 55164
ATTN: Lynn Gruber, Executive Director
Re: Proposed premium increases for MCHA policybolders
I have been an MCHA policyholder for only one
year- and am facing my third premium increase
in Jurly. I must protest.
My policy coverage began last April.
In July, I received a 15"monthly- 180 annual increase,
In March I observed my 60th birthday and faces
on increase in drinwal premiums of 336.96 because-
I moved into I higher rate based on age,
The proposed rater increase for July This year would
be 103.92 annual:
This would be a grand total of $620.88 in
premium increases for me. in 15 mas. participation
in MCHA. Furthermore, I have a $1000 deductible
policy and paid 2/1 my health care bills in the
past year out of my own pocket. I feel I am
being subjected to price gouging.
Sincerely
CC: Birt mcKasu
6470
Minneapolis MN 55426
March 23, 1994
Lynn R. Gruber, Executive Director
Minnesota Comprehensive Health Association
P.O. Box 64566
St. Paul MN 55164
Dear Lynn Gruber:
Once again, as I did last year, I feel obliged to write objecting to new
MCHA rate increases. I am doing this not only on my own behalf but also on
behalf of many of your other policyholders who are more or less in the same
circumstances as I am.
I am quite sure that a fairly high percentage of your policyholders are,
like myself, 55 or older and have taken early retirement for one reason
or another so do not have group insurance at a place of employment. As
for myself, I am now age 60. I took early retirement 3 years ago to take
care of my mother, who is now age 93. I also have some pre-existing med-
ical conditions so the only insurance I could get was MCHA. I feel there are
many people like me no cannot easily pay over $2,000 a year in insurance
premiums plus another $1,000 in deductibles before any benefit at all is
derived from the coverage. When you are not working and don't have regular
income, it is very difficult to pay these premiums in addition to other
ongoing necessary expenses. I only regret that I have to go another 41/2
years like this before I can get onto Medicare and a good, reasonable
Medicare supplement that covers virtually everything.
Many other people, like me, keep this MCHA because they are afraid to be
wihtout any insurance at all in case of a major illness or hospital stay.
Because of the deductibles and poor coverage of office calls, X-rays, lab
tests etc. people don't always.go to the doctor when they should. I know
that has been the case with me because I would end up paying for it all
myself, anyway.
To raise premiums further will just force more people to go without inaur-
ance. I thought the purpose of an insurance like this was to help make
sure everyone would have insurance. Continually raising premiums certainly
defeats this purpose.
I hope you will take thse things into consideration before approving
further rate increases.
Sincerely,
MCHAI
4
/.
56073
.94
/
Re:
deductible
$196.38
U
Dear Lynn Gruber!
Beverly in in college full-time and not at home. while Since she
my husband xl pay her insurance premium rate
is in school, we will speak to the proposed increases.
Help! Line #31 from our 1973 completed 1040 tax return income :
from her 1040 EZ tafreture is $2,527.
adjusted gross income, 15,604 Beverly's adjusted gross
We do need money to live and fa Beverly to go to
College and now we are Cooking at insurence premium Care ?
increases. When are we eligible for minesta
We can not attend any of the public meetings. We
write to you for help. Read this Thank at the meetings
if you think it will help. you,
Sincerely
mr
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DOCUMENT NO.
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003o. letter
From: Policyholder, To: Sir or Madam [partial] (1 page)
3/9/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act [44 U.S.C. 2204(a)|
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA|
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
March 9, 1994
MCHA
MEMBERSHIP
P.O. Box 64566
St. Paul, MN. 55164
RE: Increase in Premiums
MAR 61994 MAIL SERVICES
Dear Sir or Madam:
MAR 1 6 1994
I am in receipt of your letter regarding the possibility of
premium rate increases for my health insurance.
As I am working and unable to attend any of the mentioned meet-
ings, I would like to give you my thoughts in writing.
My quarterly premium now is: $514.41. I started out with approx
$356.00 quarterly. This is just for myself. I have always felt
that I am paying health insurance for those that don't or WON'T
pay health insurance premiums. I have to work just about 5
weeks to clear $500.00, and my husband is on a fixed income. That
leaves us very little for anything else. I can understand why
SOME of the people do not have health insurance, they simply can't
afford it. After feeding your children, paying the rent, and
utilities, there is nothing left over to pay it with. However,
there are some who drive new cars and sit in bars and go on vaca-
tions, that could pay insurance, but do not. Therefore, other
than it's getting almost impossible for me to pay these rates, I
have to go without to pay for those who will not pay it. The
bottom line is, if this rate increase continues, it will be an
even harder hardship for me, and I too, will join the ranks of
those not having any insurance.
1 do not mind paying my fair share, but "fair" is the key word
here and I do hope you will consider the hardship it is for
us paying these premiums. Something is wrong, terribly wrong,
if the rates increase again. I can't hang on much longer.
Thank you.
0030
(b)(6)
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Pam Cicetti
OA/Box Number: 13598
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concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
MAIL SERVICES
MAF : 1994
MEMBERSHIP
SUPPORT
MAR 0 9 1994
March 7, 1994
Minnesota Comprehensive Health Association
PO Box 64566
St. Paul, MN 55164-0566
Dear Sir / Madam:
I recently recieved a letter regarding your annual rate increase.
I am 24 years old, and have an extensive spinal fusion and Harrington rod implants,
and am in relatively constant pain. I have 3 years of a college education, which includes
half of a major in Biology, in the past two years, I have found myself incapable of
continuing in Biology because of it's demand on my concentration, and am now trying
to transfer to a different school and change to a less demanding major. It's also difficult
for me to find work in town because of the nature of work available here, medium to
heavy manual labor.]
I live with my parents, am unemployed, and have no income. Any education I receive
will be financed by loans.
I find it hard to believe that you are continuing to raise rates on people in situations like
mine.
Thank you.
Yours truly,
(b)(6)
003p
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P3 Release would violate a Federal statute [(a)(3) of the PRA]
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personal privacy |(a)(6) of the PRA]
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purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
THIS IS NOT A BILL
See enclosed note
0039
GROUP NO :
IDENTIFICATION NO
(b)(6)
PACKAGE NO:
003q
(b)(6)
1-800-382-2000, ext. 5540 (for greater Minnesota)
The MCHA Board will consider testimony from the public meetings at their April 11,
1994 meeting. Shortly after that, the Board will file their proposed rates with the
Commissioner of Commerce, James Ulland. The Commissioner can accept the
Board's proposed rates or modify them. We expect the Commissioner to make a
decision by mid-May. If new rates are approved, they become effective July 1, 1994.
If you want to comment on the proposed rates, but cannot attend any of the public
meetings, please write to me prior to April 11.
Sincerely,
Lyn R. Mubin
Lynn R. Gruber
Executive Director
Enclosure
I am unable to attend a meeting but
my increase accordang to & proposed the
feel I must express my the thoughts
sheet I received would be (quarter) 52.71-
a Trugglenow to pay my quarteely
Is there a discount for 462,00 anyone so
premium on SS. my monthly SS CR in Isn't
an 8.1% increase a large increase
I find myself strugglong along. Please
lets he fair to us - us we already
Oay a high premium
(b)(6)
003q
3-18-94
Jun Gruber:
That heing able to uttend
a public meeting an
proposed state increased I
am writing to let you
how my cancerns.
Iam an individual
who had lung cancer
Jurgery 2."2 yes ago
& therefore undergo quite
a few tests & mays
every yr. I landoh
affard to the without
Insur ance e if the
rates Continually rise
I will not be able
to affand it as it is,
I work part time
Q my Insurance is my
biggesh represe a 12.73
inchease, pediculous
I am sune There are
maxy people worse off
than I am, but I
can Madily sie why
bur economy is in
the Shape it is
march 20, 1994
wear Lann Gruber:
I have just received information regarding the
"Proposed me HEE Quarterly Rotes "which would
go into effect July 1, 1994,
bracket (60-64) and the same deductible would
quarter. I the proposed rate for same ago
On Jonuary 1, 1993 my premium the was $ 609,66 per
be $707.37 per quarter. This is a 16% increase -
in a and a half. Ican' think the of any same
thing year else that has risen 16% during the rates
time period. It is rediculous. If I
continue to increase like this it in afraid
will have to go without insurance.
2 am self employed sort pay all my own in premiums. last
year less than 1993. and I don 't All it improving
my and a half. So for this year my
nicome has not increased 16% income the is
enough to equal my 1993 income.
W. hot is a person supposed to do? Is there
any help available for those of us cought in
this dilemma? I would appreciate bearing
from you.
56001
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3/23/94
b(6)
COLLECTION:
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First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
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P3 Release would violate a Federal statute [(a)(3) of the PRA]
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P5 Release would disclose confidential advice between the President
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and his advisors, or between such advisors [a)(5) of the PRA
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
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personal privacy [(a)(6) of the PRAJ
b(7) Release would disclose information compiled for law enforcement
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C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions ((b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Meu23,1994
Deartynn.
Received at notice e my Insurance Premis is
going up again. W here will thisend.
is 72 and Fam 62 an we Con not be under
the somerfaciand we are not Payings $420.00
Pev month for Ins, we only receive 00 from
Social Security W ease really me a tight
Budget W by does the Previn have to go up
every year,
Sincerely Yours
003r
(b)(6)
(b)(6)
003r
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OA/Box Number: 13598
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HRC Health Care Correspondence 94 - M
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Freedom of Information Act - 15 U.S.C. 552(b)]
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P2 Relating to the appointment to Federal office |(a)(2) of the PRA|
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency |(b)(2) of the FOIA|
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA|
RR. Document will be reviewed upon request.
41
2
I
Lynn R. Druber
Executive Director, MCHA
P.O. Box 64566
It. Faul, Mn. 55164
Dear mr. Druber:
I will not be able to attend any of the public
mietings, but of do wish to make myself heard.
I have been insured by MCHA sirce actober 1988.
at that time, I was working outside the home and had
an income with which to pay the premiums. Now, in 1994,
I am retired and living on Social Security. with The
proposed rate increase, I will be spending 40% of my
income on health insurance premiums. Soon I will
have to decide whether I am going to buy groceries or
pay my health insurance premiums. But, I really have
no choice, because both are needed. I put it very
bluntly. I cannot afford to pay more for health incurance
Thank you for whatever help that you can give
Me.
Sincerely yours,
(b)(6)
0035
March 6, 1994
Customer Service
MAR 10 1994
Dear MCHA Board of Directors,
I have noticed that premium
it began. at this rate I soon will
rates have increased every year since
not be able to afford Insurance
Coverage. my income does not increase
at this rate, infact it has been
decreasing the last few years
I don't see why it should be
so hard for me to get insurance
inverage. l have been in the part
with several different insurance
companies through work, and have
never collected anything because my
deductable always covered my
medical expense for the year.
the last insurance I have had
for 10 years since I quit working
fuel time, but their premiums
went up so high could nolanger
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3/6/94
b(6)
COLLECTION:
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First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
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Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA|
P4 Release would disclose trade secrets or confidential commercial or
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financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
either butf every did their premiums
afford it. I never collected from them
go up so high I found that I
could not get other coverage because
off I have had diabetes the last
few years. that is why l am with
MCHA.
Please try to keep the premiums
affordable, so those that are paying
premiums Can keep on doing so, and not
maybe, end up on medical assistance.
Thank you
003t
(b)(6)
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b(6)
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Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
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b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
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financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
0034
Customer
(b)(6)
MAR 17 199
To:
Board of Directors,
know about the meetings scheduled for the
Thank you for letting the policy holders
public to give their opiorions on rate changes.
without rate increases. But I also
& realize it is difficult to run acompany
state that increases are hard to absorb
by p olicy holders. My husband is on a
low fixed income and & haven't been
working because of surgeries I've had,
and find it very difficult to find W ask
because of limited experience (veducation)
we try our best, but it is difficult
with their prices It seems at times doc tors
may your best to keep providers in line
think because of their talents, the sky is
keep their expenses in line more, and not
the limit with their costs. Perhaps they could
pass all their personal costs down to patients.
(Our car is older y doesn't workton well, so I don't
I know you will all do your best.
attempt to go to the cities) ) Thank now
A
so t write instead of
0034
(b)(6)
coming to the meeting
received
4/6/94
4-2-94
MCHA
FERGUS FALLS, MN.
LYNN R. GRUBER
EXECUTIVE DIRECTOR
DEAR MS. GRUBER
IN REGARD'S to MCHA'S RALE INCREASE
PROPOSAL, I And WRITEING THIS LETTER to
LET You KNOWN MY FEELINGS. I FEEL THE
16.1 c/o RATE INCREASE IS VERY HIGH
FOR THIS INSURANCE.
INHEN You ARE ON A FIXED INCOME
LIKE I AM, It IS VERY HARD to TAKE A
INCREASE LIKE tHis. It HAS GOLTEN to THE
PLACE INHERE You HAVE to SAY, ENOUGH
IS A ENOUGH. THE FIRST OF THIS YEAR I
RECIVED A 23,00 INCREASE A MOWTH IN MY
S.S, CHECK. MCHA HAS PROPOSED 26.88 ROLE
INCREASE. A MEHLH. tHis I.S.LL LAKE ALL MY
S.S. RAISE + MORE. IN 1992 MY MCHA INS.
INENI UP "13,00 A MONTH, IN 1993 It WEWI UP
8.68 A MEWSH, AND 26.88 A MONTH IN 1994
IS Just WAY out of LINE.
IF THIS INS, GOES UP 16.1% LIKE HAS BE
PROPOSED, It Looks LIKE I INILL HAVE to
Do SOMETHING DIFFERENT, AND RIGHT Nold At
LOOK'S LIKE I lilill HAVE to DROP MY INS.,
With NCHD, I KNOW It IS Not THE BEST
THING to Do, But INUAL CAN I Do,
HAVEING GONE +NROUGH SIX BACK SURGIES
I HAVE LIFE TIME COVERACES IL,TH WORKER'S
COMP., so MCHA & MED-P-CARE INON'T UAVE to
PAY, SHOULD I NEED ANY. MORE SURGERY ON MY
BACK. It is BECAUSE oF ALL MY BACK SURGIE:
THAT I HAVE to HAVE MCHA INS.
THANK You FOR HEARING ME out
AS EVER
PHOTOCOPY
PRESERVATION
EXECUTIVE OFFICE OF THE PRESIDENT
SEAL MASSACHUSETTS THE STATE UNITED
OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON, D.C. 20503
THE DIRECTOR
July 7, 1994
George D. Monardo
Davies Medical Center
Castro & Duboce
San Francisco, California 94114
Dear Among
Thank you very much for taking the time to send your kind words
of support, and a copy of your correspondence to the First Lady.
As you know, our success at meeting the challenges facing us all
depends on continuous hard work, and the support of people such
as yourself.
Thank you again for your thoughtfulness.
Sincerely
LEON F. PANETTA
Director
DAVIES MEDICAL CENTER
February 3, 1993
First Lady, Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
Dear Mrs. Clinton:
Congratulation upon your being named to direct and move the health care
front center and to a conclusion.
As the CEO of Davies Medical Center for the past 37 years, I've heard
and seen all the proposal that have been talked about with little action,
except the passage of Medicare by President Truman.
Upon my arrival here in 1955, I learned that non-profit organizations
need not provide its employees unemployment insurance. No one could
tell me why non-profit employees should be excluded.
In 1956 Davies provided its employees with unemployment insurance, the
first non-profit corporation in the State of California to do so. You
can imagine how many friends in non-profit corporations I had left in
San Francisco.
Legislation was enacted in 1956 and all non-profit corporations must
provide unemployment insurance. Which leads me to my favorite
quotation: "God so loved the world that He didn't send a committee."
Do away with the health insurance industry. In most instances they act
as a middle man, making a profit, buying and selling HMO (providing
windfalls for management who hold stock-option and stocks) none of this
benefits the patient.
May I suggest you expand the Medicare and Medicaid coverage to all those
you plan to cover under single payor, U.S. Government. To fund the
national health system, institute a national sales tax of cents,
individuals with incomes of $400,000 or more; husbands and wives with
incomes of over $600,000 pay a surtax of % and any one with more than
$1,000,000 a surtax of % on every $1,000,000 of income, including tax
deductible investments.
President Clinton and you are at the right place at the right time in
history to expand the present single payor national health system.
Castro & Duboce, San Francisco, California 94114 (415) 565-6000
First Lady, Hillary Rodham Clinton
February 3, 1993
Page 2
Medicare for all Americans. Cost controls have been in place for
hospital reimbursement by Medicare through Diagnostic Related Group since
1983. Cost controls are now in place for health providers through
Resource Based Relative Value Systems.
Medi-Cal hospitals negotiate with State of California, California
Medical Assistance Commission and it's tough to get your actual cost. So
the State does a helluva job for its taxpayer and not so well for
hospitals.
How does one control provider costs as they do in Canada. The
government negotiates reimbursement of services with the hospital
providers on even years and with the health care professionals, doctors,
therapists, etc., on odd years.
Thereby prohibiting a national strike from occurring, as half the health
team can't move and the other half dare not go out on strike. The voters
would make it unbearable for a striker to strike a program that provides
health coverage to all citizens of the United States of America.
You may wish to contact Jane Fulton, Ph. D. from The Health Group,
in Ottawa, Canada. She is very knowledgeable about the Canadian Health
System and is a great speaker.
I have been and am presently a member of the State of California's
"California Health Facility Finance Authority;" enclosed is my biography.
I would be pleased to talk to you, Mr. Ira Magaziner or anyone else if
you so wished.
Continued success to you and President Clinton in all your endeavors.
Cordially yours
GEORGE MONARDO
Vice Chairman & CEO
GDM:bg
encl.
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P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA)
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA|
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
GEORGE D. MONARDO
Personal Data
Birthplace:
Married:
Children:
(b)(6)
004
Residence:
Business:
Education
X-ray Technique Course, State University of lowa, lowa City - 1940-1941
U.S. Navy - 1942-1945
A.A., Long Beach City College, Long Beach, California - 1948
B.S., Business Administration, Northwestern University - 1950
Masters Degree, Hospital Administration, Northwestern University - 1951
Faculty Member, University of California Program in Hospital
Administration, Berkeley Lecturer - 1957 - 1967
Professional Lecturer and Advisor, Golden Gate University, Health
Services Management, San Francisco, California - 1974-1986
Work Experience
X-Ray Technician, City Health Department, Long Beach, California -
1946-1948
Administrative Residency, Los Angeles County Bureau of Hospitals -
1950-1951
Administrator, San Pedro Community Hospital, San Pedro, California -
1951-1955
Administrator, Franklin Hospital, San Francisco, California 1955-1966
Executive Vice President, Franklin Hospital, San Francisco 1966-1971
Chief Administrative Officer and Secretary, Franklin Hospital
Foundation - 1959-1971
President and Chief Executive Officer, Franklin Hospital Foundation -
1971
President and Chief Executive Officer, Ralph K. Davies Medical Center,
Franklin Hospital - 1972 to 1988
Vice Chairman and Chief Executive Officer, Davies Medical Center,
1988 to Present
Professional Affiliations
Fellow, American College of Hospital Administrators - 1960 to present
Member, American Hospital Association, California Hospital
Association, and Western Hospitals Association - 1955-Present
Author, Articles in professional journals
Community Activity
President, San Pedro Chamber of Commerce, San Pedro, California -
1953; Member - 1953-1955
Vice President and Director, San Francisco Comprehensive Health
Planning Council - 1968-1971
Director, San Francisco Comprehensive Health Planning Council -
1968-1974
Director, Bay Area Comprehensive Health Planning Council - 1968-1973
Director, San Francisco Health Professionals Council - 1968-1975
Director, American Association for Comprehensive Health. Planning -
1971-1972
Chairman and Member, Board of Directors, Saint Vincent's School, San
Rafael, California - 1975-1978
Director, West Bay Hospital Conference, San Francisco, California -
1976-1978, 1980-1982 (includes all hospitals located in the Counties
of San Francisco, San Mateo and Marin)
Member, City of Mill Valley's Proposition 13 Budget Committee, Mill
Valley - 1978-1979
Director, Hospital Council of Northern California - 1981 - June, 1985
National, State or Local Government Appointments
Member, Advisory Health Council, State of California, 1981-1985
Appointment made by Willie L. Brown, Jr., Speaker of the Assembly
Member, California Hospital Facilities Finance Authority, March 1983-1995
Appointment made by Willie L. Brown, Jr., Speaker of the Assembly
Member, Health Planning Law Revision Commission, State of California,
March 1982 - March 1983. Appointment made by Willie L. Brown, Jr.,
Speaker of the Assembly
Member, California Commission on Health Care Policy & Financing, 1991
Appointment made by Willie L. Brown, Jr., Speaker of the Assembly
Member, Provider Task Force to Legislative Coalition for Health Care -
Appointment by Senator David Roberti
Member, National Advisory Council on Nurse Training - 1970-1974
Appointment made by Secretary Elliot L. Richardson, Secretary of
Health, Education and Welfare on August 5, 1970 - 1974
Member, San Francisco Emergency Medical Care Committee - 1978 to
Present. Appointment made by San Francisco Board of Supervisors
Chairman, San Francisco Emergency Medical Care Committee - 1976-1980
Member, Marin County Mental Health Advisory Board - 1970-1978
Appointment made by Marin County Board of Supervisors
Chairman, Marin County Mental Advisory Board - 1974-1975
Elected Official
Mill Valley City Councilman - 1960-1964; Vice Mayor, City of Mill
Valley - 1964
Corporate Boards
Chairman and President, Franklin Holding Corporation - 1981 -
Trustee, Ralph K. Davies Medical Center, San Francisco, CA - 1972
Advisory Director, Blue Cross Northern California, - 1981-1984
Chairman and President, "M" Health Foundation - 1985 -
Director, Blue Cross of California - Woodland Hills, California - 1985-
Director, American Shared Hospital Services, San Francisco, CA - 1985 -
Director, California Hospital Insurance Corporation, Inc. Sept. 1990 -
Rev. 1/93
THE WHITE HOUSE
February 7, 1994
James J. Mongan, M.D.
UMKC School of Medicine
2411 Holmes Street
Kansas City, Missouri 64108
Dear Jim:
Thank you for your recent letter and
Annapolis address to senior congressional
staff.
With your support and dedication to
the imperative of universal coverage, I am
confident that the answer to history's
question will be, yes. The President and
I will do everything we can to make it so.
With appreciation and warm regards,
I am
Sincerely yours,
Hillary Hillary Rodham Clinton
ce Melanne
tmc
Pan do T4 + R
Truman Medical Center
2301 Holmes Street
Kansas City, MO 64108
816) 556-3153
1994
January 24, 1993
PHOTOCOPY
HRC HANDWRITING
UMKC
First Lady Hillary Rodham Clinton
The White House
Washington, D.C.
University of Missouri-
Kansas City
Dear Mrs. Clinton:
School of Medicine
2411 Holmes Street
Kansas City, MO 64108
I thought you might be interested in the attached, especially pages 10 to 13.
816)235-1808
FAX: (816)235-5277
After listening to Senators Moynihan and Dole this past week or so, it is clear
that the struggle to achieve Universal Coverage will continue to be difficult.
At this point it appears that a bipartisan backing away from Universal Coverage
due to a distaste for mandates and taxes has already begun.
James J. Mongan, M.D.
The only thing that might make this year different will be the continued effort
Executive Director, TMC
put forth by you and the President to keep the nation focused on the historic
Dean, UMKC
goal of Universality.
School of Medicine
We have never before had a President and First Lady, who could, and would,
go before the cameras a few days before each key committee vote on the
inevitable substitute motion gutting Universality, and focus the American
people on the consequence of that vote.
Your continued efforts will be essential. If there is any way I can help, please
let me know.
Sincerely,
James
Jun J. Mongan, hogh M.D.
Executive Director, TMC
Dean, UMKC School of Medicine
ΓMC is the primary hospital
or the University of
Missoun-Kansas City
Schools of Medicine, Dentistry,
Nursing and Pharmacy
equal opportunity Institutions
KEYNOTE ADDRESS
RETREAT FOR SENIOR CONGRESSIONAL STAFF
Sponsored by:
Alliance for Health Reform
Catholic Health Association
Annapolis, Maryland
January 7, 1994
Presented by:
Dr. James J. Mongan
Executive Director, Truman Medical Center
Dean, University of Missouri-Kansas City School of Medicine
1
The one hundred congressional staff people here this morning, will play an
absolutely critical role in the health care debate over the next nine months. For every one of
you, whether a relative new-comer or a seasoned veteran, in some sense, all of your career
to this point has been a preparation for nine months you will probably never forget. And, I
suspect for most of you, what you do in the next nine months, may have more impact on
our nation and its people than what you will do over the rest of your careers.
That is not intended to be a depressing thought-it is merely intended to point out
how the tides of history and the courses of people's lives are such that a few key people,
such as yourselves, end up in a critical place at a critical time.
I believe that I was asked to speak today, because, in a sense, I "walked in your
shoes" a few decades back, and had an opportunity to deal with some of the pressures,
questions, conflicts and uncertainties which you face today. I served as a member of the
Senate Finance Committee staff from 1970 to 1977, and then with the Carter Administration
at HHS and the White House, from 1977 to 1981.
In the next fifteen minutes I would like to distill the most important lessons I learned
in those eleven years, and since.
Fifteen minutes forces focus, and I will focus on the one most important tension in
this debate-the tug between the desire for Universal Coverage on the one hand, and the
2
desire to avoid taxation and mandates on the other. There are many other very important
issues-cost control issues, benefit issues, administrative issues -but none of them will
define the debate, and shape the outcome, as much as the tension between coverage and
financing.
It was the financing issue that sank health insurance proposals in the Ways and
Means and Finance Committees in the early to mid 1970s; and that sank the Carter
Administration's proposal in the late 1970s. So I will focus my remarks on this tension
between coverage and financing.
I will proceed as follows:
First, I'll say a word about coverage, and why it is central to this debate,
Then, I'll focus on the major competing approaches to financing coverage,
Then, I'll say a word about some middle ground among these approaches,
and,
I'll close with a hard headed word or two, on politics.
Why do I assert that coverage, and specifically Universal Coverage, is central to this
debate? For three reasons. First, because there is a real problem out there. Most of you
accept that, although if indeed you are representative of your principal's views, there are
probably ten or twenty percent of you who are not convinced it is a real problem.
3
An attack has already begun and will continue, not so much on the validity, but on
the meaning of the oft-quoted number of 37 million people without insurance in the United
States. Some attempt to minimize the impact of that number by pointing out that some of
these people are between jobs and without coverage for less than three months. But in fact,
about 85% of these 37 million are without coverage for more than three months. And, a full
analysis must go on to point out that 61 million, or 26% of our people, are without coverage
at some point over a two year period. All 61 million suffer some risk, anxiety and
uncertainty, and many million more are locked into jobs for fear of losing coverage.
One other point on this problem-it is not just an economic problem-it is a health
problem for the millions of chronically uninsured Americans. Some like to say that the
uninsured get medical care when they need it. Though that is very often true for dramatic,
acute, occurrences like child birth or exposed fractures, it is most often not true for chronic
killers such as hypertension, diabetes and heart and respiratory diseases which frequently
go untreated in their early controllable stages.
The second reason Universal Coverage is central to the debate, involves its
relationship to controlling costs, the other important driving force in this debate. Most
members of Congress, are somewhat nervous about heavily regulatory approaches to
controlling costs. Most of these in turn, particularly the more conservative, have embraced
"Managed Competition" as a more politically palatable approach to cost control. But,
"Managed Competition" cannot work without very broad coverage. You simply cannot
4
expect health plans to compete, when carrying varying burdens of indigent care. The
physicians and hospitals within a plan will in fact be forced to exclude the uninsured making
their situation even worse than today. This link between Managed Competition and
Universal Coverage has been preached at length by the most senior advocates of the
Market Place, such as Alan Enthoven and Paul Ellwood, and it is an issue which will not
conveniently go away.
The third reason Universal Coverage is central to the debate, is political. In my
opinion, there will be a major political back-lash if a bill passes which does not provide very
broad coverage. People's expectations about their coverage now, and the security of that
coverage in the future, have been raised by both Democratic and Republican rhetoric. The
debate has been cast as among competing means to achieve very broad coverage-none
advertise their bills as falling far short of Universal Coverage. If we end up with vague,
unfinanced goals for broader coverage, millions will feel duped and misled.
Now, although there is broad support for the principle of Universal Coverage from
among a broad variety of groups-State and Local Government groups, business and labor
groups, provider and consumer groups, Seniors, Children's and Minority groups, and
Religious organizations - although there is broad support; there is less support, and even
less consensus, on the financing needed to make broad improvements in coverage a
reality. There is, as I have said, a tension between coverage and financing which lies at the
very heart of the debate you are about to begin.
5
As you all well know, there have been three generic approaches put forth to finance
broad improvements in coverage. Let me very briefly review each and their important pros
and cons.
First are the all-payor approaches, modeled on Canada or our own Medicare
program; which would levy a direct federal tax, which would in good part
replace private premiums, and federalize the financing of our health care
system. The arguments in favor of this approach are that it could, and indeed
does in a number of other countries, achieve the goal of Universal Coverage,
and that it arguably could limit many current administrative expenses
associated with private insurance. There are also downsides to this approach
and I'll mention two. First, it would involve a substantial increase in the level of
federal taxation, and most members of Congress seem not to believe that
they can explain to constituents, the extent to which those taxes replace
current private insurance premiums. Secondly, this approach with its very
visible governmental role runs directly against the anti-big government ethos
of our society.
The second approach to financing broad coverage expansion, has been the
employer mandate approach which seeks to build upon the current
public/private system by mandating health insurance payments by all
6
employers, and establishing federal subsidies for the unemployed and heavily
impacted small businesses. The advantage of this approach is that since
over three-quarters of the uninsured have a relationship to the labor market,
you could with some additional subsidy for those not related to the labor
market, achieve very broad coverage expansion. Again, this model has been
extensively used in other countries. Another advantage of this approach, in
the eyes of some, is that it can be less disruptive to our current system than
many other approaches. A major downside appears to be significant
opposition from the Small Business community, in spite of any subsidies
offered. Another downside to the employer mandate is that given the
complexity of the current labor market and family employment patterns,
employment based approaches become very complicated, very rapidly.
The third approach to financing broad coverage expansions has involved
the concept of an individual, rather than an employer mandate, under which
all individuals would be required to have health insurance coverage, with
subsidies for those with low income. This approach has the strong political
appeal of avoiding the fierce battle over employer mandates and yet seeming
at the same time to offer a route to Universal Coverage. But this approach,
too, has its problems. One is a concern about potentially encouraging many
employers who offer coverage, to drop that coverage. Some employers might
7
maintain coverage, some might substitute higher wages or other benefits and
some might invest the resources elsewhere. A thorough analysis of the range
of potential impacts would be useful to the debate. The other major concern
regarding an individual mandate is that its effectiveness in achieving Universal
Coverage is heavily dependent upon the adequacy of the subsidies made
available. With so much attention focused on the federal cost of all-payor
approaches, and employer mandate approaches, there has not yet been a full
opportunity to debate the federal subsidy cost associated with an individual
mandate. Any such analysis would be dependent upon two assumptions -
the cost of a proposed benefit package, and an assumption about what
percent of their income families can, and should be reasonably expected to,
apply to the costs of mandated health insurance payments. It is more than
likely that the individual mandate approach, to be at all effective in expanding
coverage substantially, will entail the need for significant subsidies and tax
increases. We should begin the important analysis of these numbers.
One more word about a financing issue common to all three financing structures.
Advocates of all three approaches attempt to minimize the extent of taxes or mandated
premiums by relying on savings from current health expenditures. Many members of
Congress would like to say that all additional federal costs could, would and should be
offset by reductions in federal costs for Medicare and Medicaid resulting in broadly
8
expanded coverage with no new taxes-surely the dream of anyone who must run for
office. But, I urge you all to watch the math very carefully. Very real savings in Medicare
and Medicaid would result from comprehensive health reform. But, it is highly unlikely that
the costs of adequately subsidized Universal Coverage, could be offset by Medicare and
Medicaid savings alone, and any such assertion should be examined very carefully. In
particular, proposals to phase in coverage expansions only when federal savings have
been achieved, must be analyzed and projected with great care; lest we promise the voters
soon, something which might well not be achieved in our lifetime.
Let me turn now from this analysis of competing approaches to financing, and focus
for a moment on the possibilities of combining elements of each. It is not my intent this
morning to attempt to set out a so-called compromise proposal.
I have neither the standing nor the position to attempt that task. I would only like to
suggest the obvious-that is that these three competing approaches can be mixed in a
number of ways. Let me just mention a few, illustratively.
If the issue of an employer mandate and its impact on small employers, in particular,
seems problematic, one might want to look at limiting the employer mandate to firms with
more than 25 or 50 workers and combining that with an adequately subsidized individual
mandate for workers in smaller firms. Yes, there would be issues of potential employer
evasion at the firm-size margin, but given the percent of larger employers who already offer
9
coverage, it should be an issue that could be dealt with. A number of funding sources could
be explored to subsidize the individual mandate including sin taxes, limiting deductibility for
health insurance premiums and other taxes. There might also be an element of extensions
of Medicare coverage, to early retirees, or to those disabled for 12 as opposed to 24
months, or to other groups, which might be helpful in structuring a mixed approach to
financing.
There is a great deal of room for "politics" in its best and most noble form, as you
and your principals grapple with this critical set of issues.
Now let me conclude my remarks, with a hard headed word or two on politics. As I
said, I have seen major proposals to provide comprehensive coverage founder on at least
two occasions-the Nixon and Kennedy-Mills proposals in the early 1970s and the Carter
proposal in the late 1970s. They foundered on the tension between coverage expansion
and financing. More specifically, there are two political currents which dragged these
proposals under.
First, although a majority of the public and their representatives appear to favor
Universal Coverage, there are a significant number, particularly on the conservative side of
both parties who subordinate the desire for Universal Coverage to the desire to avoid any
new taxes or mandates. This year, our nation, its citizens and their representatives will have
10
to face, in a more public and focused spotlight than ever before, this tradeoff between the
desire to broaden coverage and the desire to avoid any taxes or mandates.
With a normal "inside the Beltway" political decision, that kind of trade-off is made in
the minds of members of Congress. With the attention that will be focused on this issue, the
trade-off will be made in the minds of millions of our more informed citizens. Our
representatives -- your bosses -- will do what they do very well: they will attempt to read
that voter sentiment as it develops.
Ultimately this issue will come down to a political judgment which will be made as
this spring progresses, mostly by members of the conservative wings of both parties, as
they look to the November election. They will have to sense the degree to which the public
really values broader more secure health insurance coverage. They will then decide to
either support broad legislation and attempt to put as conservative a stamp on it as
possible, or pass limited legislation, judging that the voter's desire for broader coverage and
security is thin and little back-lash will result; or, if they sense little support at all for broader
coverage and security, they will stalemate the issue and run in November on a platform
minimizing health concerns and stressing opposition to taxes and mandates.
I believe many of your principals have not yet made that judgment, and that much of
their decision will be determined by the developing mood of the public as this debate takes
shape.
11
The second major current which blocked passage of comprehensive legislation twice
in the 1970s was what I would label "incrementalism", Our Government tends to operate
incrementally-generaly not taking bold steps but rather building gingerly on what has
been built before. There are two reasons for this.
First, on most issues you have a fair proportion of the population that does not want
things to change, and will tend to oppose any major change. In addition, our system of
government is structured to make change difficult-with numerous hurdles any major
legislation must pass, and numerous chokepoints to block passage.
So there is a strong tendency to work incrementally, and at the margin of many
issues , given the difficulty of passing sweeping change.
But here again, there is a judgment which will be made over the next nine months.
There will be a strong temptation to avoid comprehensive legislation, eliminating all
mandates and eliminating Universality, and to work at the margins on Medicare, Medicaid
and private insurance market reforms. But, in the glare of public attention will that be
enough? Imagine your principals in the papers and on the talk shows, after passage of
minimalist incremental legislation, being pressed as to how many million remain uninsured,
as to what happens when people lose their coverage, and as to how we will deal with
continued health care cost increases and their impact on the federal budget and our
12
economy. Incremental legislation might not seem as attractive after passage, as it might
appear before.
Yes, we do operate incrementally-but we also take bold steps as a nation-when
the public is ready. And, it is in fact these bold steps-not the rest of what we do-that are
remembered by history. Get out your college history books over the next few weeks. See
how little mention is made of most domestic legislation. Note the bold steps that are
mentioned-steps such as the Federal Reserve legislation of 1913, Social Security in 1935
and the Civil Rights and Voting Rights Act of the 1960s.
With respect to the issue you will be grappling with these next nine months, history
will have only one question-Is everybody covered? Passage of Universal Coverage will be
historic. Small market insurance reform, modest Medicaid expansion, limits on Medicare
spending will not meet history's test.
If the American people are indeed seeking the security of Universal health care
coverage, and if the American people want our Country -- the greatest nation on earth -- to
meet the test so many other countries, without our riches, have met; then members of
Congress will recognize that desire, and they -- and you -- will play a part in shaping
History.
13
tmc
Truman Medical Center
2301 Holmes Street
Kansas City, MO 64108
(816) 556-3153
August 31, 1994
First Lady Hillary Rodham Clinton
The White House
UMKC
Washington, D.C.
Dear Mrs. Clinton:
University of Missouri-
Kansas City
About a year ago, I prepared the attached chart "The Slippery Slope from
School of Medicine
Universality" which, unfortunately, accurately depicted the deterioration of the drive
2411 Holmes Street
Kansas City, MO 64108
for universal coverage and laid out how that deterioration would unfold. It gives me
(816)235-1808
FAX: (816)235-5277
no pleasure to have seen this scenario play-out over recent months.
I am writing to a number of Executive and Legislative Branch officials at this time
because of my strong concern that the debate has now deteriorated well beyond what I
foresaw a year ago. I have attached a second chart called "The Slippery Slope to
James J. Mongan, M.D.
Diminished Coverage" which illustrates how we appear to be heading for a situation
which would result in the deterioration of the existent Medicare and Medicaid
Executive Director, TMC
Dean, UMKC
programs for the poor and the elderly, and the potential for decreased private
School of Medicine
coverage.
The continued deterioration of this debate poses a major challenge to those who favor
reform. There is an old saying among those who favor incremental change, "Do not let
the best become the enemy of the good". There is much wisdom in that expression.
However, supporters of reform must watch carefully for that point at which an
incremental approach does more harm than good. In short, the good must remain the
enemy of the bad.
As the search for an "incremental" approach begins inevitably to veer towards
diminished coverage, doing nothing will at some point become better than slipping
backwards. It would be better to continue the fight for true reform into 1995 or even
1997 if that proves necessary.
Sincerely,
11 my
James J. Mongan, M.D.
Executive Director, TMC
Dean, UMKC School of Medicine
TMC is the primary hospital
for the University of
Missouri-Kansas City
Schools of Medicine, Dentistry,
Nursing and Pharmacy
equal opportunity institutions
SLIPPERY SLOPE FROM UNIVERSALITY
Begin With Universal Coverage Through
Employer Mandate and Expanded Public Program
Universal Coverage
Full Employer Mandate
Limit benefits
Covered by Mandate
Exclude certain employers and employees
From Mandate
Extend phase-in over 6-8 years
Make phase- in conditional on economy and budget
(Final Carter compromise)
Abandon Employer Mandate
Individual Mandate with Adequate
Subsidy (Requires Large Tax Increase)
Contingent Individual Mandate - Subsidize Purchase
Contingent on Savings in Government Health Costs
(No New Taxes, No Real Mandate, No Universality)
(Senate Republican Position)
Facilitate, but do not subsidize
Small group and individual coverage
(No New Taxes, No Mandate, No Universality)
Establish Empty Goal for Coverage with
No Financing
Prepared By:
Dr. James J. Mongan
- Executive Director, Truman Medical Center
- Dean, University of Missouri-Kansas City, School of Medicine
SLIPPERY SLOPE FROM UNIVERSALITY - Part II
SLIPPERY SLOPE TO DIMINISHED COVERAGE
End Point of Previous Chart
Inability To Agree On Financing
Results In Establishment Of Empty Goal
Abandon Goal Of
For Universal Coverage
With No Financing
Universal Coverage -
Substitute 95% Coverage
As Functional Equivalent
Overtly Disavow Goal Of Universal
Coverage - Seek Expansion Of Coverage
To 91% Through Subsidies Contingent On Savings
From Medicare And Medicaid Budget Cuts -
Set Deficit Reduction As Higher
No Broad Taxes Or Mandates
Goal Than Any Expansion of
Coverage - Slash Medicare And Medicaid
To Reduce Deficit 100 Billion - If Any
Funds Remain Apply To Coverage Expansion
NEW BOTTOM OF SLOPE
No Universal Coverage
No Goal For Universal Coverage
No Guaranteed Expansion of Coverage To Any Target Level
Establishment Of 100 Billion Deficit Reduction
As Precondition for Any Expansion
Significant Reductions In Medicare And Medicaid
For Poor And Elderly (With No Off-setting Benefits)
Insurance Market "Reforms" With Potential To Drive
Up Rates And Decrease Coverage When Not Tied To
Prepared By:
Universal Coverage
Dr. James J. Mongan
- Executive Director, Truman Medical Center
- Dean, University of Missouri-Kansas City, School of Medicine
August 30, 1994
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
005a. letter
From: Hillary Rodham Clinton, To: Ms. Mary Musk (1 page)
10/28/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRAJ
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA|
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
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AND TYPE
005b. letter
From: Mary Musk, To: Hillary Clinton (3 pages)
10/6/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
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Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
005c. memo
From: Karen Guss, To: File, Re: letter from Mary Musk (2 pages)
11/21/94
b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Pam Cicetti
OA/Box Number: 13598
FOLDER TITLE:
HRC Health Care Correspondence 94 - M
2014-0159-S
sb291
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA|
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA|
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA|
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
THE WHITE HOUSE
March 16, 1994
Ms. Blanche Moore
Director of Institutional Relations
Arkansas Children's Hospital
800 Marshall Street
Little Rock, Arkansas 72202-3591
Dear Blanche:
Thank you for your letter and for
passing on the information from NACHRI.
It was good to hear from you again and I
appreciate your keeping me informed.
With warm regards, I remain
Sincerely yours,
Hillary 1 Lillary Rodham Clinton
bee Melanne
03/07/94
11:16
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RESEARCH ADMIN.
002
ARKANSAS
SHILDREN'S HOSPITAL
800 Marshall Street, Little Rock, Arkansas 72202-3591, (501) 320-1100 or TDD (501) 320-1184
Jonathan Bates, MD.
Chief Executive Offices
Betty A. Lowe, MD
Medical Director
March 7, 1994
Phillip K. Giimore, M.S., MHA
Administrator
Larry C. Woodard. F.A.H.P.
Mrs. Clinton
Director of Development
The White House
and Community Affairs
Blanche Moore
Washington, DC 20500
Director of Institutional Relations
Paul Fitzgerald, PhD.
Director of Planning & Clinics
Dear Mrs. Clinton:
William J. Bogle
Ella Christopher, RN
Thank you so much for spending the time talking with me on
Scott Gordon LCS.W.
Associate Administrator
Thursday. I 2001 enclosing the information you requested
Board of Trustees
regarding TennCare. Many state Medicaid managed care programs
Diane Mackey
will be detrimental to children's hospitals, but TennCare probably
President
represents the most damaging system so far. I understand that
Wayne Cranford
Vice President
you will not be able to speak to NACHRI, but I thought you might
Walt Bennett
still want this information.
Secretary
Robert L. Shults
Treasurer
I hope that you will be able to put in 2 good word for the
Robert Arrington M.D.
Arkausas Children's Hospital Nutrition Center with Secretary
Chief of Staff
Guy Amsler. Jr.
of Agriculture Espy.
John Bale, Jr.
Jonathan Bates M.D.
It's such a delight to visit The White House and see all the
Paula Boaz
David M. Clark
Arkansans working there. You and the President have really
Robert C. Cress
made the people of Arkansas feel a part of your success.
Eddie Drilling
Harry C Erwin III
Herschel H. Friday
Sincerely,
Barnett Grace
Gerald F. Hamra
Mrs. Robert Hickman
Blauche
Dick Holert
Judge Marion Humphrey
Blanche Moore
MA Jackson, M.D.
Director of Institutional Relations
Drake Keith
Betty A.Lowe M.D:
Martha Markland
Sheree Meyer
Mrs. Malcolm Moore
Robert D. Nabhoz
Mary Reynolds
Enclosure
Skip Rutherford
Betty Tucker
Roy C Turner III
Larry C Wallace
Harry P. Ward. M.D.
Charles B. Whiteside III
Emeritus
John HL Bale
Stanley M. Bauman, Jr.
Hillary Rodham Clinton
William R Meeks
Louis Rosen
Frank D. White
A major teaching affiliate of the University of Arkansas for Medical Sciences
03/07/94
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RESEARCH ADMIN.
003
The National Association of Children's Hospitals
and Related Institutions, Inc.
CHILDREN'S HOSPITALS KEY CONCERNS WITH TENNCARE
March 1994
Children's hospitals are supportive of Medicaid managed care
programs for their potential to improve children's access to
services and provide timely preventive and primary care services.
When major problems occur, as they have in the case of TennCare,
they primarily are due to why and how a state designs and
implements its program rather than fundamental flaws in the
overall concept.
The TennCare program is of concern not only to the children's
hospitals in the state of Tennessee but to all children's
hospitals because of its precedent-setting potential. A number
of state Medicaid programs have indicated their intent to adopt a
TennCare-like approach to reforming their Medicaid programs.
The major concerns children's hospitals have with the TennCare
program include:
INADEQUATE FINANCING
Tennessee excludes costs for graduate medical education
(GME), capital and disproportionate share hospital (DSH)
payments from the Medicaid cost base used to determine the
capitation rates.
The Medicaid program nationwide is generally recognized as
being underfinanced. Excluding these significant costs
makes it unlikely that managed care organizations can pay
children's hospitals adequate reimbursement rates. Most
children's hospitals are primary teaching sites for
pediatricians and pediatric subspecialists. They are also
important Medicaid disproportionate share hospitals (DSHs).
The loss of medical education and DSH funds will place a
tremendous financial burden on children's hospitals.
Tennessee has agreed to develop two "supplemental pools" for
GME and "essential providers" but does not have to guarantee
to finance the pools. The definition of "essential
provider" is the prerogative of the state and Tennessee will
give first priority to all its public hospitals.
Inadequate capitation rates are further discounted to
reflect expected charity care contributions from providers;
the availability of local government funding; and
deductibles and copayments to be collected by managed care
plans and/or providers.
401 Wythe Street, Alexandria, Virginia 22314
Phone 703/684-1355
FAX 703/684-1589
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004
Tennessee assumes that, on average, providers give five
percent charity care. Children's hospitals which devote
nearly half of their care to low income children experience
significant levels of uncompensated care due to Medicaid
shortfalls and other charity care. The impact of these
discounts will fall disproportionately on children's
hospitals and other high volume providers of care to low
income populations.
NO ASSURANCE OF ACCESS OF CHILDREN TO ESSENTIAL PEDIATRIC
PROVIDERS
TernCare does not require that managed care organizations
(MCOs) contract with essential providers nor does it
guarantee that children's hospitals will be designated as
essential community providers. In Tennessee and in
metropolitan areas around the county, children's hospitals
have become an essential safety net to children of low
income families, especially those assisted by Medicaid.
With the pressures created by inadequate capitation rates
and no requirement that MCOs contract with children's
hospitals, children enrolled in some managed care plans may
not have access to any children's hospital services.
TennCare does not recognize "centers of excellence" for
child health. MCOs must demonstrate to the state that it
has adequacy capacity to serve expected enrollees but no
standards are in place requiring children' access to
appropriate providers including pediatric subspecialists or
pediatric tertiary inpatient services. Centers of
excellence for children's specialized care needs are not
recognized under TennCare. Parents of children assisted by
Medicaid, particularly those with congenital or chronic
conditions, may not be afforded the option to choose
pediatric specialized providers for the care of their
children.
NO SPECIAL CONSIDERATIONS FOR CHILDREN WITH SPECIAL HEALTH CARE
NEEDS
TennCare does not recognize explicitly the special
circumstances of children with special health care needs.
Tennessee has little experience with the enrollment of
children with special health care needs in managed care
plans and has not developed any special access and quality
standards to assure these children have timely access to
pediatric specialists and are not underserved due to
financing pressures.
TennCare does not provide adequate risk adjustment for
children with special health care needs. TennCare has
developed eight capitation rates based primarily on age and
2
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RESEARCH ADMIN.
005
sex criteria, not health status. Risk adjustment is
essential to avoid the negative effects of adverse selection
under managed care, when a provider such as a children's
hospital receives a greater number of high risk patients but
receives payment based on an" average" patient. Children's
hospitals are particularly vulnerable to adverse selection
ELES, on average, more than 70 percent of their care is to
children with chronic or congenital conditions. Tennessee
has also not established alternatives to risk-adjusted
capitation such as stop-loss or reinsurance.
Tennessee has little prior experience with capitated, risk-based
managed care systems and programs and this lack of experience and
resources, along with an aggressive implementation timetable,
serves to exacerbate the problems outlined above.
Tennessee has had little experience with commercial or Medicaid
managed care organizations operating within the state. About
120, 000 state employees are enrolled in a Blue Cross/Blue Shield
Preferred Provider Organization. Medicaid managed care
experience is even less, with only 16,000 Aid to Families with
Dependent Children (AFDC) women and children currently enrolled
voluntarily in one health insuring organization. Under TennCare,
the state plans to enroll 1,000,000 Medicaid recipients and
300, 000 uninsured individuals during 1994, the first year of
implementation.
As stated in its waiver request, Tennessee also does not plan to
hire additional staff during this first year of implementation.
Nor did the state involve providers, recipients or patient
advocaties in its planning process. This gap between Tennessee's
ambitious plan as well as aggressive timetable and the state's
lack of existing capacity and resources have thus far created
numerous enrollment, communication and service delivery problems.
As a comparison, California, a state nationally recognized as a
managed care leader and with 20 years experience with Medicaid
managed care, is taking a more reasoned approach to its plan to
expand its Medicaid managed care program. California already has
enrolled 600,000 (12%) of its Medi-Cal population into managed
care programs. Its new managed care plan has as a goal enrolling
50 percent of Medi-Cal recipients over a three year period.
As more states move aggressively to establish or expand Medicaid
managed care plans, state capacity, resources, financing and
implementation design and schedule, plus involvement and support
of the provider and patient community, must be key considerations
in assessing the feasibility and reasonableness of a state's
proposal.
3