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American Nurses Association, Washington, D.C.6-18-96 [1]
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Comission language
drafted by
Chris Jennings
domestic violence
From M. Yager personal extreme
issues
4
001
06/17/96 11:12
202 690 6562
DHHS/ASPE/HSP
FAX TRANSMISSION
DEPARTMENT OF HEALTH & HUMAN SERVICES
ASSISTANT SECRETARY FOR PLANNING AND EVALUATION
OFFICE OF HUMAN SERVICES POLICY
PHONE: 202/690-7148
FAX: 202/690-6562
To: Terry Edminds
Date: 6-17-96
Fax #:
456-5709
Pages: 2
From:
Paul Legler
Subject:
COMMENTS:
002
06/17/96 11:13
202 690 6562
DHHS/ASPE/HSP
DRAFT
STATES THAT HAVE ADOPTED NEW HIRE REPORTING PROGRAMS
Alaska
Arizona
California
Connecticut
Florida
Georgia
Hawaii
Iowa
Kentucky
Maine
Maryland
Massachusetts
Minnesota
Missouri
New York
Ohio
Oklahoma
Oregon
South Carolina
Tennessee
Texas
Vermont
Virginia
Washington
West Virginia
06/17/96
11:13
202 690 6562
DHHS/ASPE/HSP
003
DRAFT
NEW HIRE REPORTING PROGRAMS SHOW SUCCESS
Twenty-five states currently have new hire programs in place. New hire programs enable states to
locate delinquent parents very quickly through the receipt of employment information. These
programs have lead to striking improvements in locating parents who owe support and to dramatic
increases in collections. The following are examples of state programs that are operating across the
country:
Florida started its new hire program in January, 1995. In 1995, Florida's new hire reporting
program resulted in over 8,000 matches for outstanding child support cases; the annual amount of
support owed under these cases is $15.2 million. An additional 50,000 matches were made for
other child support-related activities, such as paternity establishment.
Iowa implemented its new hire program in January, 1994. The state estimates that it has added $5
million to its collections for 1995 as a result of new hire reporting.
Massachusetts began its program in March, 1993. Since March, 1993, the state has matched new
hire information with 137,329 non-paying parents. The state estimates that in 1995, new hire
information yielded $15.4 million in increased child support, saving an estimated $21.6 million from
welfare case closures.
Missouri began its new hire program in August, 1994. Missouri estimates that the program
collected $12 million in 1995. Over 10 percent of the 721,000 new hires reported in 1995 owed
child support or were wanted in paternity establishment cases.
New York implemented its new hire program in April 1996. Already, the state has processed
404,000 new hire reports (10,000-12,000 a day) with about a 7 percent match rate. New York
estimates that it will collect $14-$15 million annually as a result of the program.
Virginia implemented its program in July, 1993. As of December 1995, the state had matched
almost 200,000 child support cases through its new hire program and estimates that total collections
from these cases are in excess of $20 million. Of this, $7.2 million was used for welfare payment
savings. In fact, the state estimates that total savings to the AFDC, Medicaid and Food Stamp
programs from the new hire program equal over $1.2 million in monthly benefits.
Washington implemented its new hire program on July 1, 1990. New hire reporting is documented
as the state's most cost effective child support enforcement tool. For every dollar the state spends
on its new hire program, it gains approximately $20 in child support collections. Washington
collected $7.8 million in the first 18 months of its program, half of which was used to decrease
welfare payments and save taxpayers money.
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
Acknowledgments: Ginna Trotter Betts for her gracious introduction and for her
four years as national president of ANA. She has been a great friend to both the Vice
President and me. And hers has been a leading voice in our common struggle to enact
meaningful health care reform. As she moves on to other ventures, I want to join all of you
in thanking her for her brilliant leadership, and in wishing her well.
I am honored to join you in this 100th anniversary celebration. Today, I ask all
Americans to join me in saluting you for a century of service, leadership and advocacy for
quality health care. Building a healthy nation starts with building healthy people. That has
always been your mission. It is generally recognized that, for all its shortcomings, America
has the finest health care system in the world -- the best doctors, the best hospitals, the best
technology. But none of this would matter without you, America's nurses -- the heart and
soul of our nation's health care system.
I know the hard work and sacrifice that goes into being a good nurse. As most of
you know, for more than 30 years, my mother worked as a nurse anesthetist. I want to
thank you again for honoring her memory in 1994 with a special award in her name. I have
vivid memories of her getting up in the middle of the night to be at work by 7 a.m. She was
serious about the life and death nature of her work. She was the consummate professional.
But she understood that healing is about more than medicine and technology. It is also about
caring. So she always added a dose of compassion -- a kind word, a gentle touch, a smile --
to put her patients at ease and to reassure them that everything would be alright. That is
what good nursing is all about. That is what all of you do everyday.
Excellence and compassion are also the hallmarks of this organization. Long before
health care reform became the issue it is today, you stood with us to fight for better access
and quality of care for millions of Americans. And you have also stood with us in other
fights -- the nomination of Dr. Foster, our budget battles, and our struggles to protect
Medicare and Medicaid.
You have also stood tall for the rights and dignity of nurses. You have led the fight
for collective bargaining, better wages, better working conditions, better training -- not only
for your members, but for the millions and millions of nurses in this country who benefit
from your strong and principled leadership. We all owe you a great debt of gratitude.
But today, I want to talk to you about how all Americans can join you in the most
important work you do -- strengthening families and communities. My administration is
committed to expanding opportunity for every citizen who is willing to take responsibility for
making the most of their lives. The key to doing that is strengthening the American family.
1
You see the need for this every day. A big part of your job is to impress upon your
patients the need for them to take more personal responsibility for their health and for the
health of their families. All the doctors and nurses in the world will not save a person who
refuses to eat right, get the proper exercise, get regular check-ups or refrain from smoking
or excessive drinking. But for those who do, the rewards are real.
But you cannot do this job alone. Government also has a role to play. As you know,
for more than 30 years Medicaid has also played a critical role in strengthening families. In
1965, Americans reached common ground around the belief that quality medical care should
be guaranteed to our most vulnerable citizens -- poor children, pregnant women, older
Americans and the disabled. But last year, the Republican Congress sent me legislation that
would have resulted in the denial of care for millions of these people. You said no. I said
no. And the American people said no. Leave Medicaid alone. I vetoed that legislation.
And, let me assure you, if they send it to me again in the same form, I will veto it again.
We also know that one of the most important things we can do right now to
strengthen families and expand access to health care in this country is to pass the Kassebaum-
Kennedy insurance reform bill. No worker in this country should have to worry that he or
she will lose their health care if they lose their job or change jobs. And no one should be
denied care simply because they have a pre-existing condition. When you go to a patient's
bedside you ask, "Where does it hurt? How can I help?" You don't ask whether this is pre-
existing condition you are looking at. So I ask you to join me in calling on the Congress to
pass this important legislation now.
But, you and I know that, where children are concerned, the most important building
block of strong families is parents who love their children and take responsibility for their
care. Parents have the responsibility for pre-natal care, for making sure their newborns get
the pediatric attention and immunizations they need. And for nourishing them with the love
and financial support that is vital to their growth.
Parental responsibility has also been the driving principle behind our efforts to
change our welfare system from one that fosters dependency to one that promotes work,
family and independence. I am proud that, under my Administration, three out of four
AFDC recipients -- more than 10 million people -- are now covered by state initiated reforms
that we approved.
Just today, we approved a waiver for a welfare reform effort in New Hampshire,
which combines strong work requirements with incentives to move people from welfare to
work. This makes the 63rd waiver in 40 states since I took office. With our support, states
are reforming welfare by requiring work, time-limits, making work pay, improving child
support enforcement and encouraging parental responsibility. And I am doing everything I
can to help this process. Last month, I took executive action to require minor mothers to
stay in school and turn their lives around in order to receive assistance. Today, 1.3 million
fewer people are on welfare than when I took office. In addition, the food stamp rolls are
2
collections have reached a record high.
But we must do more, especially in the area of child support enforcement. Already,
we have proposed and the Congress has adopted, a requirement for states to establish
hospital-based paternity programs as a way to establish paternities early in life. Early data
from 31 states indicates that more than 200,000 paternities were established through in-
hospital paternity identification programs last year. Altogether, in 1995, our federal and
state efforts resulted in the collection of a record $11 billion from non-custodial parents, an
increase of nearly 40 percent since 1992. We also increased paternity establishment 40
percent from 1992 to 1995. But we have to do more.
How many times have you seen a frightened young girl give birth to a baby alone in
the hospital, with the father of the child no where to be found? How many times has the
hospital and the government been left to pay the costs, not only for the delivery but for the
continuing care of that child? That is wrong. It takes two people to bring a child into this
world, and it takes two people to raise that child. That is why today, I am taking executive
action to strengthen child support enforcement and promote parental responsibility.
While we continue to wait for the Congress to pass comprehensive welfare reform
that promotes work and protects children, I am directing the Department of Health and
Human Services to issue new regulations which will require all mothers who apply for
welfare to provide the name of the father and other identifying information at the time they
apply for assistance, before they can get welfare benefits. Exceptions will be made to
protect women from domestic violence or for other extreme personal circumstances. Welfare
applicants must also be referred to the state child support agency within two days so that the
agency can initiate a legal paternity action.
new
I am also announcing a new priot program to help states track parents who owe child
support across state lines. Twenty-five states currently require that when a person is hired
for a job, a check is made to see if he owes child support. This pilot program will allow
under
states to send that information to the federal office of child support to help in our interstate
collection efforts.
Thirty child percent support Earlled the coment intentale micolve
this new Pill program
Our system ought to say to mothers: help us identify and locate the father, or you
Couses
we
cannot get welfare. And it should say to fathers you must support your children, and we
a parent
are going to do everything in our power to see that you do. As I have said many times,
check info infunt that
who
parents have the primary responsibility for raising ghildren, not the government.
Government does whare children, Parentsda
hased
Our goal in all of this is to strengthen families, protect children, and demand more
across
responsibility from both parents. These are the goals that you and most Americans are
state
outional
working hard every day to make real. I believe the federal government has a responsibility
Jing.
to support those efforts. Good health means not only what nurses and doctors can do for us,
Perents
many
datatch
but what we can do together to raise healthy children and strong families. One of the best
things we can do is to demand that fathers and mothers take an active role in nurturing and
who
deadbeats
to
many
one
too
3
pupportis
childsupp.
weasel orging to job state. more child and must to stop.
Today the
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
Acknowledgments: Ginna Trotter Betts for introduction -- she is leaving after four
years as national president of ANA. She was a leading voice for health care reform.
I am honored to join you in this 100th anniversary celebration. Today, I ask all
Americans to join me in saluting you for a century of service, leadership and advocacy for
quality health care. Building a healthy nation starts with building healthy people. That has
always been your mission. It is generally recognized that, for all its shortcomings, America
has the finest health care system in the world -- the best doctors, the best hospitals, the best
technology. But none of this would matter without you, America's nurses -- the heart and
soul of our nation's health care system.
I know the hard work and sacrifice that goes into being a good nurse. As most of
you know, for more than 30 years, my mother worked as a nurse anesthetist. I want to
thank you again for honoring her memory in 1994 with a special award in her name. I have
vivid memories of her getting up in the middle of the night to be at work by 7 a.m. She was
serious about the life and death nature of her work. She was the consummate professional.
But she understood that healing is about more than medicine and technology. It is also about
caring. So she always added a dose of compassion -- a kind word, a gentle touch, a smile --
to put her patients at ease and to reassure them that everything would be alright. That is
what good nursing is all about. That is what all of you do everyday.
What I learned from my mother and what America is learning from you are the basic
values that make us strong. We know that the mission of this country must be to offer every
American an opportunity and demand that every American take responsibility -- that is the
basic bargain of our democracy. I think if we do that we can create a strong America that is
rooted in strong communities and strong families. This is so important. Without strong
families our children will not get the support and the guidance they need to take advantage of
the vast opportunities of the 21st century. Without strong families, our communities will not
produce the leadership needed to face the challenges of this new era.
For the past three-and-a-half years, we have worked hard to give people the tools
they need to raise strong and healthy families. That is why we passed the Family and
Medical Leave Act. That is why we have fought so hard to preserve the guarantee of health
care for millions of Americans who depend on Medicaid. And that is why we are doing
everything we can to enact the vital health insurance reforms that are at the heart of the
Kassebaum-Kennedy bill. We have also been working to demand responsibility from every
citizen. That means making sure every American does what it takes to make the most of his
or her God given abilities. And it means making sure that every parent lives up to the
obligation they owe to their children.
1
Today, I want to talk with you about how we can work together to build strong
families and to guarantee that every child in this country has not only the health care they
need, but also the parental support, from both mothers and fathers, that is critical to their
well-being.
There is much that we can do as citizens, but government also has a role to play. As
you know, for three decades, through the Medicaid program, we have had a national
commitment that poor children, pregnant women, people with disabilities and older
Americans will not be denied health care simply because they can't afford it. Now, under
the Republican congressional plan, hundreds of thousands of our children with disabilities
could lose their home care. Children that are seriously ill could lose some of their coverage
from what is now available. This could amount to child neglect for a whole generation.
That is why I vetoed this plan last year when the Republican Congress sent it to me. And let
me assure you, if they send it to me again, I will veto it again.
We also know that one of the most important things we can do right now to
strengthen families and expand access to health care in this country is to pass the Kassebaum-
Kennedy insurance reform bill. No worker in this country should have to worry that he or
she will lose their health care if they lose their job or change jobs. And no one should be
denied care simply because they have a pre-existing condition. When you go to a patient's
bedside you ask, "Where does it hurt? How can I help?" You don't ask whether this is pre-
existing condition you are looking at. So I ask you to join me in calling on the Congress to
pass this important legislation now.
But, you and I know that, where children are concerned, the most important building
block of strong families is not government. It is not nurses and doctors. It is parents,
mothers and fathers who love their children and take active responsibility for their care.
It is parents who have the responsibility for pre-natal care, for making sure their newborns
get the pediatric attention and immunizations they need. And for nourishing them with the
love and financial support that is vital to their growth.
Parental responsibility has been the driving principle behind our efforts to fix our
broken welfare system. I want welfare reform because our present system perpetuates a
cycle of dependency and irresponsible behavior. Quite simply, the system is broken and we
need to replace it with a one that one that promotes work, family and independence -- one
that makes welfare a way up, not a way of life. I believe we have to require work, set strict
time-limits, make work pay, improve child support enforcement, and demand parental
responsibility while making sure children have the health care and child care they need.
That is real welfare reform.
I have worked with Congress to make these important changes, but they have sent me
bills that have been tough on kids and soft on work. But, we have not let this stop us.
While Congress has not done its job, we are acting to support real welfare reform. I am
proud that, under my Administration, three out of four AFDC recipients more than 10
2
million people -- are now covered by state initiated reforms that we approved.
Just today, we approved a waiver for a welfare reform effort in New Hampshire,
which combines strong work requirements with incentives to move people from welfare to
work. This makes the 63rd waiver in 40 states since I took office. With our support, states
are getting the job done. And I am doing everything I can to help this process. Last month,
I took executive action to require minor mothers to stay in school and turn their lives around
in order to receive assistance. Today, 1.3 million fewer people are on welfare than when I
took office. In addition, the food stamp rolls are down, the poverty rate is down, teen
pregnancy rates are down, while work and training among welfare recipients are up and
child support collections have reached a record high.
But we must do more to insist on parental responsibility. Our welfare reform
proposals are about giving people opportunity and demanding responsibility in return. I
reject the idea that this applies only to women. Every child has both a mother and a father.
And for too long, we have let men off the hook. We must insist that they do their part to
support the children they helped bring into this world.
How many times have you seen a frightened young girl give birth to a baby alone in
the hospital, with the father of the child no where to be found? How many times has the
hospital and the government been left to pay the costs, not only for the delivery but for the
continuing care of that child? That is wrong. It takes two people to bring a child into this
world, and it takes two people to raise that child.
That is why three years ago, we proposed and the Congress adopted, a requirement
for states to establish hospital-based paternity programs as a way to establish paternities early
in life. Based on our first reports, more than 200,000 fathers have been identified through
these hospital paternity identification programs last year. That's 200,000 children whose
fathers can't just up and walk away without a trace. Altogether, in 1995, our federal and
state efforts resulted in the collection of a record $11 billion in child support from non-
custodial parents, an increase of nearly 40 percent since 1992. We also increased paternity
establishment 40 percent from 1992 to 1995. But we have to do more. That is why today, I
am taking executive action to strengthen child support enforcement and promote parental
responsibility.
First, I am announcing a new national program to help states track parents who owe
child support across state lines. Today, too many men have figured out that the way to
weasel out of paying child support is to move from job to job and state to state. This must
stop. Currently, twenty-five states require that when a person is hired for a job, a check is
made to see if he owes child support. Under this new program, we will check that
information against our national database to catch deadbeats who have crossed state lines.
Secondly, today I am directing the Department of Health and Human Services to
issue new regulations which will require all mothers who apply for welfare to provide the
3
name of the father and other identifying information at the time they apply for assistance,
before they can get welfare benefits. Exceptions will be made to protect women from
domestic violence. These new regulations will also require the welfare office to contact child
support authorities within two days so that the agency can initiate a legal paternity action
against the father.
Our system ought to say to mothers: help us identify and locate the father, or you
cannot get welfare. And it should say to fathers -- we are not going to let you walk away
from your children and stick the taxpayers with the tab. As I have said many times,
government does not raise children, parents do.
Our goal in all of this is to strengthen families, protect children, and demand more
responsibility from both parents. These are the goals that you and most Americans are
working hard every day to make real. I believe the federal government has a responsibility
to support those efforts. Good health means not only what nurses and doctors can do for us,
but what we can do together to raise healthy children and strong families. One of the best
things we can do is to demand that fathers and mothers take an active role in nurturing and
providing for the children they bring into this world.
Thank you and God bless you all.
4
DRAFT
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
Acknowledgments: Ginna Trotter Betts for her gracious introduction and for her
four years as national president of ANA. She has been a great friend to both the Vice
President and me. And hers has been a leading voice in our common struggle to enact
meaningful health care reform. As she moves on to other ventures, I want to join all of you
in thanking her for her brilliant leadership, and in wishing her well.
I am honored to join you in this 100th anniversary celebration. Today, I ask all
Americans to join me in saluting you for a century of service, leadership and advocacy for
quality health care. Building a healthy nation starts with building healthy people. That has
always been your mission. It is generally recognized that, for all our shortcomings,
America has the finest health care system in the world the best doctors, the best hospitals,
the best technology. But none of this would matter without you, America's nurses -- the
heart and soul of our nation's health care system.
I know the hard work and sacrifice that goes into being a good nurse. As most of
you know, for more than 30 years, my mother worked as a nurse anesthetist. I want to
thank you again for honoring her memory in 1994 with a special award in her name. I have
vivid memories of her getting up in the middle of the night to be at work by 7 a.m. She was
serious about the life and death nature of her work. She was the consummate professional.
But she understood that healing is about more than medicine and technology. It is also about
caring. So she always gave a little extra a kind word, a gentle touch, a smile -- a dose of
compassion to put her patients at ease and to reassure them that everything would be alright.
read
That is what good nursing is all about. That is what all of you do everyday.
equal
give pedro learned from respen ker dailywork strey. have is values strey Twen
Excellence and compassion are also the hallmarks of this organization. Long before
without
health care reform became the issue it is today, you stood with us to fight for better access
and quality of care for millions of Americans. And you have also stood with us in other
familes
fights -- the nomination of Dr. Foster, our budget battles, and our struggles to protect
Flat's
Medicare and Medicaid.
why
me
Fant
And you have stood up for the rights and dignity of nurses. You have led the fight
appd.
leave
for collective bargaining better wages, better working conditions, better training not only
for your members, but for the millions and millions of nurses in this country who benefit
from your strong and principled leadership. We all owe you a great debt of gratitude.
also
report
But today, I want to talk to you about how all Americans can join you in the most
today-
important work you do strengthening families and communities. My administration is
to talh In gouy
committed to expanding opportunity for every citizen who is willing to take responsibility for
about
making the most of their lives. The key to doing that is strengthening the American family.
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You see the need for this every day. A big part of your job is to impress upon your patients imp
the need for them to take more personal responsibility for their health and for the health of
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their families. All the doctors and nurses in the world will not save a person who refuses to
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eat right, get the proper exercise, get regular check-ups or refrain from smoking or excessive hener
drinking. But for those who do, the rewards are real.
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But you cannot do this job alone. Government also has a role to play. As you know,
our
for more than 30 years Medicaid has also played a critical role in strengthening families. In
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1965, Americans reached common ground around the belief that quality medical care should
must
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be guaranteed to our most vulnerable citizens poor children, pregnant women, older
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Americans and the disabled. But last year, the Republican Congress sent me legislation that
would have resulted in the denial of care for millions of these people. You said no. I said
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no. And the American people said no. Leave Medicaid alone. I vetoed that legislation.
And, let me assure you, if they send it to me again in the same form, I will veto it again.
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We also know that one of the most important things we can do right now to
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strengthen families and expand access to health care in this country is to pass the Kassebaum- address
Kennedy insurance reform bill. No worker in this country should have to worry that he or
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she will lose their health care if they lose their job or change jobs. And no one should be
denied care simply because they have a pre-existing condition. When you go to a patient's
march)
bedside you ask, "Where does it hurt? How can I help?" You don't ask whether this is pre-
existing condition you are looking at. So I ask you to join me in calling on the Congress to
pass this important legislation now.
But, you and I know that, where children are concerned, the most important building
block of strong families is parents who love their children and take responsibility for their
care. Parents have the responsibility for pre-natal care, for making sure their newborns get
the pediatric attention and immunizations they need. And for nourishing them with the love
and
financial
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Parental responsibility has also been the driving principle behind our efforts to
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change our welfare system from one that fosters dependency to one that promotes work,
family and independence. I am proud that, under my Administration, three out of four
AFDC recipients more than 10 million people are now covered by state initiated reforms
that we approved.
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twe need to fly said regure work, time health limits,
Just today, we approved a waiver for a welfare reform effort in New Hampshire,
which combines strong work requirements with incentives to move people from welfare to child cad
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are reforming welfare by requiring work, time-limits, making work pay, improving child
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support enforcement and encouraging parental responsibility. Due in large part to these
policies, 1.3 million fewer people are on welfare today than when I took office. In addition, bibs
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while work and training activities among welfare recipients are up and child support
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But we must do more, especially in the area of child support enforcement. Already,
we have proposed and the Congress has adopted, a requirement for states to establish
hospital-based paternity programs as a way to establish paternities early in life. Early data
from 31 states indicates that more than 200,000 paternities were established through in-
hospital paternity identification programs last year. Altogether, in 1995, our federal and
state efforts resulted in the collection of a record $11 billion from non-custodial parents, an
increase of nearly 40 percent since 1992. We also increased paternity establishment 40
percent from 1992 to 1995. But we have to do more.
How many times have you seen a frightened young girl give birth to a baby alone in
the hospital, with the father of the child no where to be found? How many times has the
hospital and the government been left to pay the costs, not only for the delivery but for the
continuing care of that child? That is wrong. It takes two people to bring a child into this
world, and it takes two people to raise that child. That is why today, I am taking executive
action to strengthen child support enforcement and promote parental responsibility.
While we continue to wait for the Congress to pass comprehensive welfare reform
that promotes work and protects children, I am directing the Department of Health and
Human Services to issue new regulations which will require all mothers who apply for
welfare to cooperate with paternity establishment as a condition of receiving assistance:
before they Can 80t welfare benefits
Our system ought to say to mothers: help us identify and locate the father, or you
cannot get welfare. And it should say to fathers -- you must support your children, and we
are going to do everything in our power to see that you do. As I have said many times,
parents have the primary responsibility for raising children, not the government. Under
these new regulations, mothers will be required to provide the name of the father and other
identifying information at the time they apply for assistance, before they begin to receive
benefits. Exceptions will be made to protect women from domestic violence or for other
extreme personal reasons. Welfare applicants must also be referred to the state child support
agency within two days so that the agency can initiate a legal paternity action. And-states
will have greater flexibility to have child support agencies determine compliance with
paternity establishment requirements
Our goal in all of this is to strengthen families, protect children, and demand more
responsibility from both parents. These are the goals that you and most Americans are
working hard every day to make real. I believe the federal government has a responsibility
to support those efforts. Good health means not only what nurses and doctors can do for us,
but what we can do together to raise healthy children and strong families. One of the best
things we can do is to demand that fathers and mothers take an active role in nurturing and
providing for the children they bring into this world.
Thank you and God bless you all.
3
DRAFT
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
Acknowledgments: Ginna Trotter Betts for her gracious introduction and for her
DONT
four years as national president of ANA. She has been a great friend to both the Vice
President and me. And hers has been a leading voice in our common struggle to enact
meaningful health care reform. As she moves on to other ventures, I want to join all of you
in thanking her for her brilliant leadership, and in wishing her well.
I am honored to join you in this 100th anniversary celebration. Today, I ask all
Americans to join me in saluting you for a century of service, leadership and advocacy for
quality health care. Building a healthy nation starts with building healthy people. That has
always been your mission. It is generally recognized that, for all its shortcomings, America
has the finest health care system in the world -- the best doctors, the best hospitals, the best
technology. But none of this would matter without you, America's nurses -- the heart and
soul of our nation's health care system.
I know the hard work and sacrifice that goes into being a good nurse. As most of
you know, for more than 30 years, my mother worked as a nurse anesthetist. I want to
thank you again for honoring her memory in 1994 with a special award in her name. I have
vivid memories of her getting up in the middle of the night to be at work by 7 a.m. She was
serious about the life and death nature of her work. She was the consummate professional.
But she understood that healing is about more than medicine and technology. It is also about
caring. So she always added a dose of compassion -- a kind word, a gentle touch, a smile --
to put her patients at ease and to reassure them that everything would be alright. That is
what good nursing is all about. That is what all of you do everyday.
Excellence and compassion are also the hallmarks of this organization. Long before
health care reform became the issue it is today, you stood with us to fight for better access
TOOCH
and quality of care for millions of Americans. And you have also stood with us in other
fights -- the nomination of Dr. Foster, our budget battles, and our struggles to protect
Medicare and Medicaid.
You have also stood tall for the rights and dignity of nurses. You have led the fight
for collective bargaining, better wages, better working conditions, better training -- not only
for your members, but for the millions and millions of nurses in this country who benefit
from your strong and principled leadership. We all owe you a great debt of gratitude.
But today, I want to talk to you about how all Americans can join you in the most
important work you do -- strengthening families and communities. My administration is
committed to expanding opportunity for every citizen who is willing to take responsibility for
making the most of their lives. The key to doing that is strengthening the American family.
1
THMIC
You see the need for this every day. A big part of your job is to impress upon your
patients the need for them to take more personal responsibility for their health and for the
health of their families. All the doctors and nurses in the world will not save a person who
refuses to eat right, get the proper exercise, get regular check-ups or refrain from smoking
or excessive drinking. But for those who do, the rewards are real.
But you cannot do this job alone. Government also has a role to play. As you know,
for more than 30 years Medicaid has also played a critical role in strengthening families. In
1965, Americans reached common ground around the belief that quality medical care should
be guaranteed to our most vulnerable citizens -- poor children, pregnant women, older
Americans and the disabled. But last year, the Republican Congress sent me legislation that
would have resulted in the denial of care for millions of these people. You said no. I said
no. And the American people said no. Leave Medicaid alone. I vetoed that legislation.
And, let me assure you, if they send it to me again in the same form, I will veto it again.
We also know that one of the most important things we can do right now to
strengthen families and expand access to health care in this country is to pass the Kassebaum-
Kennedy insurance reform bill. No worker in this country should have to worry that he or
she will lose their health care if they lose their job or change jobs. And no one should be
denied care simply because they have a pre-existing condition. When you go to a patient's
TOOTESY
bedside you ask, "Where does it hurt? How can I help?" You don't ask whether this is pre-
existing condition you are looking at. So I ask you to join me in calling on the Congress to
pass this important legislation now.
But, you and I know that, where children are concerned, the most important building
block of strong families is parents who love their children and take responsibility for their
care. Parents have the responsibility for pre-natal care, for making sure their newborns get
the pediatric attention and immunizations they need. And for nourishing them with the love
and financial support that is vital to their growth.
Parental responsibility has also been the driving principle behind our efforts to
change our welfare system from one that fosters dependency to one that promotes work,
family and independence. I am proud that, under my Administration, three out of four
AFDC recipients -- more than 10 million people -- are now covered by state initiated reforms
that we approved.
Just today, we approved a waiver for a welfare reform effort in New Hampshire,
which combines strong work requirements with incentives to move people from welfare to
work. This makes the 63rd waiver in 40 states since I took office. With our support, states
are reforming welfare by requiring work, time-limits, making work pay, improving child
support enforcement and encouraging parental responsibility. And I am doing everything I
can to help this process. Last month, I took executive action to require minor mothers to
stay in school and turn their lives around in order to receive assistance. Today, 1.3 million
fewer people are on welfare than when I took office. In addition, the food stamp rolls are
2
down, the poverty rate is down, teen pregnancy rates are down, while work and training
among welfare recipients are up and child support collections have reached a record high.
But we must do more to insist on parental responsibility. Three years ago, we
proposed and the Congress adopted, a requirement for states to establish hospital-based
Based
paternity programs as a way to establish paternities early in life. Early data from 31 states
on
our
indicates that more than 200,000 paternities were established through in-hospital paternity
out
identification programs last year. That's 200,000 children whose fathers can't just up and
best
walk away without a trace. Altogether, in 1995, our federal and state efforts resulted in the
collection of a record $11 billion from non-custodial parents, an increase of nearly 40
percent since 1992. We also increased paternity establishment 40 percent from 1992 to
1995. But we have to do more.
How many times have you seen a frightened young girl give birth to a baby alone in
the hospital, with the father of the child no where to be found? How many times has the
hospital and the government been left to pay the costs, not only for the delivery but for the
continuing care of that child? That is wrong. It takes two people to bring a child into this
world, and it takes two people to raise that child. That is why today, I am taking executive
action to strengthen child support enforcement and promote parental responsibility.
While we continue to wait for the Congress to pass comprehensive welfare reform
that promotes work and protects children, I am today directing the Department of Health and
Human Services to issue new regulations which will require all mothers who apply for
welfare to provide the name of the father and other identifying information at the time they
apply for assistance, before they can get welfare benefits. Exceptions will be made to
protect women from domestic violence. Welfare applicants must also be referred to the state
child support agency within two days so that the agency can initiate a legal paternity action.
I am also announcing a new national program to help states track parents who owe
child support across state lines. Today, too many men have figured out that the way to
weasel out of paying child support is to move from job to job and state to state. This must
stop. Currently, twenty-five states require that when a person is hired for a job, a check is
made to see if he owes child support. Under this new program, we will check that
information against our national database to catch deadbeats who have crossed state lines.
Our system ought to say to mothers: help us identify and locate the father, or you
cannot get welfare. And it should say to fathers -- we are not going to let you walk away
from your children and stick the taxpayers with the tab. As I have said many times,
government does not raise children, parents do.
Our goal in all of this is to strengthen families, protect children, and demand more
responsibility from both parents. These are the goals that you and most Americans are
working hard every day to make real. I believe the federal government has a responsibility
to support those efforts. Good health means not only what nurses and doctors can do for us,
3
but what we can do together to raise healthy children and strong families. One of the best
things we can do is to demand that fathers and mothers take an active role in nurturing and
providing for the children they bring into this world.
Thank you and God bless you all.
4
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
Acknowledgments: Ginna Trotter Betts for introduction -- she is leaving after four
years as national president of ANA. She was a leading voice for health care reform.
I am honored to join you in this 100th anniversary celebration. Today, I ask all
Americans to join me in saluting you for a century of service, leadership and advocacy for
quality health care. Building a healthy nation starts with building healthy people. That has
always been your mission. It is generally recognized that, for all its shortcomings, America
has the finest health care system in the world -- the best doctors, the best hospitals, the best
technology. But none of this would matter without you, America's nurses -- the heart and
soul of our nation's health care system.
I know the hard work and sacrifice that goes into being a good nurse. As most of
you know, for more than 30 years, my mother worked as a nurse anesthetist. I want to
thank you again for honoring her memory in 1994 with a special award in her name. I have
vivid memories of her getting up in the middle of the night to be at work by 7 a.m. She was
serious about the life and death nature of her work. She was the consummate professional.
But she understood that healing is about more than medicine and technology. It is also about
caring. So she always added a dose of compassion -- a kind word, a gentle touch, a smile --
to put her patients at ease and to reassure them that everything would be alright. That is
what good nursing is all about. That is what all of you do everyday.
What I learned from my mother and what America is learning from you are the basic
values that make us strong. We know that the mission of this country must be to offer every
American an opportunity and demand that every American take responsibility -- that is the
basic bargain of our democracy. I think if we do that we can create a strong America that is
rooted in strong communities and strong families. This is so important. Without strong
families our children will not get the support and the guidance they need to take advantage of
the vast opportunities of the 21st century. Without strong families, our communities will not
produce the leadership needed to face the challenges of this new era.
For the past three-and-a-half years, we have worked hard to give people the tools
they need to raise strong and healthy families. We passed the Family and Medical Leave
Act to say that if you take a little time off to take care of a sick child you will not lose your
job We have been fighting with all of you to preserve the guarantee of health care for
millions of Americans who depend on Medicaid. And we are doing everything we can to
enact the vital health insurance reforms that are at the heart of the Kassebaum-Kennedy bill.
Through our efforts to reform welfare, we have also been working to demand responsibility
from every citizen. That means making sure every American does what it takes to make the
most of his or her God given abilities. And it means making sure that every parent lives up
1
Page 3
7TH DOCUMENT of Focus printed in FULL format.
Public Papers of the Presidents
May 10, 1994
CITE: Weekly Comp. Pres. Doc. 1044
LENGTH: 4219 words
HEADLINE: Remarks to the American Nurses Association Conference
BODY:
Thank you so much. Thank you for your warm welcome. And thank you, Ginna,
for that award.
I arrived a few moments ago, and I re member the first time I ever heard your
president speak. I knew that she had worked for Vice President Gore, and I
thought it was so interesting to hear the head of a national association who was
speaking without an accent. [Laughter]
I want to say a special word of appreciation to your first vice president,
Ellen Sanders, who's participated in White House and congressional meetings on,
health reform, and to Diane Weaver, the president of the Association of Nurse
Executives, who cosponsored this breakfast.
I am very proud to share the stage today with all the fine nurses in the
executive and the legislative branches whom you have honored. And I thank you
for doing that. And I thank them for their service. I also want to say a
special word of thanks to all of you and to the ANA for the courage and the
vision you have demonstrated by fighting for health care reform, and the right
kind of health care reform, long before it was a hot issue. As you know, the
position paper you put out on national health reform probably more closely
parallels the recommendations that our administration has made than that of any
other professional health care group in the country. And I thank you for that
very much.
I want to thank you, too, for recognizing my mother, who worked for 30 years
and then some as a nurse and was deeply proud of what she did. I remember when
I was little boy watching her get up in the middle of the night always starting
work by 7 a.m. or 7:30 a.m. in the morning, always telling me stories that
indicated that there was literally nothing in the world more important to her
than dealing with a person frightened, in pain, with a caring and effective
manner. This award will help to expand the frontiers of nursing in the areas of
women's health, something that she would have been very proud to be a part of.
My mother, as all of you now know, completed her memoirs, which became her
autobiography shortly before she died. She went over about half of it and was
able to do the final editing. And it was my privilege after she passed away to
work with the author and just try to make sure all the facts were right. I got
very stern instructions from her. She said, "Now if you have to do this do not
change one word I said about you" [laughter] -- "especially the part about
your manners not always being great. [Laughter] "And make sure you get the
facts straight. Otherwise leave it alone.
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But I was very pleased with the two book reviews that her book got yesterday.
One by the great American author, Joyce Carol Oaks in the New York Times, and
then another one here in the Washington Post. But it tickled me, the one in
the
Washington Post said that if you read this book, you would understand why I
perplexed people in Washington. I was actually brought up by real people, and
occasionally I still acted like one. [Laughter] I didn't know what that
[laughter] I'm trying to get over it, but it's hard even here.
Anyway, here's something my mother said about her work, which would apply to
all of you and those whom you represent. But it meant a lot to me. It was just
her words. "Nurse anesthetist work is all-consuming. You don't do it halfway.
You don't daydream. You don't let your emotions wander. You're the person
responsible for putting another human being into a state of unconsciousness,
somewhere between life and death. For 30 years, from the minute that I would
walk into the operating room and start talking to the patient and begin putting
him to sleep, until I got him safely back to the recovery room, nothing in the
world could have crossed my mind. I don't care what problems were on the
outside. I don't care what problems I might have been having at home. I never
thought of my life beyond the moment."
I remember when I was also a child, things were somewhat more informal. My
mother used to take me to the hospital and let me meet the other nurses and the
doctors and watch the emergency room and watch people go into the operating
room. It was utterly fascinating. And the work you do has always sort of
captured my imagination.
My own wife had never been in a hospital before in her entire life until our
daughter was born, never been in a hospital for any kind of sickness. And
learned only a few moments before the happy event that she was going to have to
have a C-section. And we had gone through Lamaze, and we had done all this
stuff, and I was supposed to be in the operating room. And our hospital at that
time had never before let a father into the delivery room if it wasn't a natural
birth. It was a big deal. So I said, "Look, I've been watching people get cut
on and bleed since I was a little boy. I'll do fine. [Laughter] "But she had
never been here before, and she may not you better let me come in."
[Laughter] So they did and actually changed the policy SO that if fathers had
been through the Lamaze course and then the mothers eventually had to have a
C-section, they got to go. So I felt that's my one contribution to medical
advances. [Laughter]
But I owe all that to my mother, who was a remarkably determined woman in the
face of often excruciating adversity. I think one of the reasons that the
Nurses Association has been so forthright about this health care reform issue is
that you see it from the grassroots up in human terms and you don't get so hung
up as some people do on all the political rhetoric and the positioning and the
characterizations that have, frankly, put a lot of Members of Congress at a
severe disadvantage because they haven't had the chance to spend the time and
make the effort to deal with this issue that you have. It is, after all, a
mind-bendingly complex problem. It's 14.5 percent of our income, and for people
who don't live in it every day, it can be a very difficult thing.
But I just wanted to thank you because I believe that the personal
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Public Papers of the Presidents
FOCUS
experiences you have shared, so many of you common to the ones that my own
mother shared, really animated the Nurses Association to take the position that
you have taken.
I want to emphasize today that what I seek, contrary to the attacks, and what
you have sought, is not a Government-run health system, it's a private insurance
health system that covers everybody, where the health care professionals run it
and not the insurance companies. That's what we seek.
We seek private insurance that can never be taken away. It's wrong to treat
seriously ill children in an emergency room who could have been treated more
easily and more inexpensively if their parents had just had the coverage. With
our reforms, every family will have that kind of quality insurance. We ought to
reform the insurance system that today often only covers the healthiest people
and even then will deny them coverage for anything they've been sick with
before.
When you go to a patient's bedside, you ask, "Why does it hurt? Where does
it hurt? How can I help?" You don't ask whether this is a preexisting condition
you're looking at. [Laughter] It's a very important issue.
If you think about all this preexisting condition business, there are 81
million Americans who live in families where there's been a child with diabetes
or a mother that had cancer prematurely or a father that had an early heart
attack or some other problem. I see these people everywhere. This is no small
number. Now, we get action lickety-split up here all the time when a million
people or 2 million people are adversely affected by something if they are well
organized. But these 81 million people, they're professionals and blue-collar
workers; they're old folks and young folks; they're all different kinds of
people; and they are by definition disorganized. There is no national
association of people with preexisting conditions. [Laughter] You think about
it; if there were, and 10 million of them showed up here, we'd have health care
reform so fast you couldn't blink.
You must be their voice in an organized way. And you can be. So we ought to
cover everybody with private insurance, and we ought to have insurance reforms
that deal with preexisting conditions and don't discriminate people based on
age. This is somewhat controversial. I know that. But I believe if we went
back to health insurance the way it originally was when Blue Cross first started
writing it, where everybody was put in a large group, risk was broadly spread,
and people paid a fee against the day when they would be sick, it would be
fairer for all Americans. And our economy would work better, our society would
have a stronger sense of community, our families would function better. People
would be free of a lot of the anxiety that comes
Hillary and I have received about a million letters. And whenever I go
somewhere now, they arrange for some of the letter writers to come see me. And
it's just gripping to see people just over and over and over and stunning to see
how they do come from all walks of life and how they have been broken by the
things which have happened.
The third thing I think we should do is to preserve the Medicare program.
It's interesting, the people who criticize our program say this is
Government-run health care which, of course, it isn't. And if you tried to take
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FOCUS
away Medicare, which is a Government-funded health care, well, they would be up
in a tree somewhere screaming about it.
But we don't want to do anything to the Medicare program, except to make it
better. I do believe we should add a prescription drug benefit and phase in
long-term care that is community-based or home-based for two simple reasons.
One is, there are an awful lot of elderly people who aren't poor enough to be on
Medicaid but aren't well off, who have significant medical bills. We know the
elderly use 4 times the prescription drugs that the nonelderly do. And we know
from study after study after study that a proper medication regime can keep
people out of the hospital and can save money and that we now. have any
number of elderly people every month -- I was in a grocery store in New York
yesterday called Pathmark, which also operates, as many do now, a drugstore.
And it was gripping; the CEO was saying, "My workers tell me that every day they
watch older people come in this store and go from the drugstore, down the food
aisle, and try to make up their mind what food they're going to give up to get
their medicine, or whether they're going to give up their medicine to buy their
food" gripping. So I do believe we should do that. But the Medicare program
works. It has low administrative overhead. We think it should be secured.
The fourth thing we want to do is to bring greater choice to our people. I
guess the thing that has made me the maddest in the relentless campaign against
this plan are all those bogus ads where they say, "You're going to have to call
some Government office to figure out where you go to the doctor."
There are two realities of modern life that you have to drive home to every
Member of Congress, without regard to party or philosophy. Number one,
Americans are rapidly losing their choices today. Already, of people who are
insured at work, fewer than half have more than one choice of a health plan.
That's a fact today. And they're rapidly losing their choices. Number two,
medical professionals are increasingly losing their right to decide
unilaterally, may have to have somebody get on the phone to an insurance company
executive a long way away to ask for permission to do what anybody knows ought
to be done under the circumstances.
Now, most Americans, believe it or not, don't know either one of those
things, even though they may be caught up in it, and I think it's very
important. Our plan is designed, number one, to increase the choices that
consumers have. We're moving to more managed care. There can be a lot of good
things in it, but under our plan, every year, every person would have a choice
between at least three plans, or among at least three plans but in all
probability many more. And number two, under our plan, medical professionals
would also be given more choices and would have to do less checking in with the
insurance company in advance. Now, being treated by doctors and nurses, you
know, is an American tradition. Every time I do one of these town meetings,
like I did in Rhode Island last night, I talk to somebody that's just been
forced to give up their doctor and just move away from the choices they made.
We believe when all Americans can choose among several health plans, many
Americans, many more Americans, will choose to stay with their own providers.
And many more of these plans will be organized in such a way that all providers
can participate if they'll do it for the agreed-upon fee. That's what we
believe will happen. And if we don't do this, if we don't have some legal
action to reorganize this, you're going to have less choice by consumers, less
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choice by providers.
Time and again, we've also seen that the quality of care is directly related
to the quality and the quantity of the nursing staff. One of the things that
amazes me is how man) nurses have been laid off in recent months and been told,
well, this is because health care reform is coming. I'll tell you what, one of
Clinton's unbending laws of politics is, whenever somebody who's got a tough
decision to make can shift the heat from themselves to you, they'll do it every
time. They will do it every time. That law never varies.
Now, what is really going on? What's really going on is, a lot of these
health care providers are under the gun. Right? More managed care; people
bargaining tougher for prices; more and more people who are uncovered where
there's uncompensated care that has to be provided; less and less ability to
pass on the cost of uncompensated care to other people because they're in these
managed care networks they're in: all this stuff is going to happen if we don't
do anything. All of us could go on vacation for a year, and this same thing
would go on. You know that. And don't let your Members fall for it.
What's going to happen is we'll continue to see these trends occur unless we
find a way to give health care providers reimbursement for all the people for
whom they care, at an appropriate level in an appropriate way. More than a
decade of research now shows that more and better trained nurses result in
shower hospital stays, better survival rates, fewer complications, whether
you're dealing with low birthweight babies or older people.
You do not have to work for the Congressional Budget Office to understand
that healthier patients and shorter stays means lower health care costs.
Sometimes I think if you do work for the Congressional Budget Office you will
never get that, but -- [laughter] we're working pretty well on the whole.
This is a big deal. This choice issue and maintaining an array of qualified
people doing the things for which they are best qualified is terribly important.
Finally, let me say and this, I guess, is, except for this whole issue of
whether this is a Government program, which it isn't, is the most controversial
part of it -our reform is based on providing guaranteed benefits at work.
Now the reason for that is simple, for the people in this country that have
health insurance, 9 out of 10 of them have it at work where there is some shared
responsibility between the employer and the employee. For the people who don't
have insurance, 8 out of 10 of them have someone in their family who is working.
It seems to me that the fairest and simplest, and if you will, the most
conservative way to achieve universal coverage, to have health care security for
everybody, is to ask employers and employees who aren't doing anything or barely
doing anything to do more so that they can fulfill their own responsibilities
and then use tax funds to cover the unemployed, uninsured people for whom you
could say, "Well, there's a general responsibility just like Medicare and
Medicaid" and then organize the market so that smaller businesses and
self-employed people, (a) get discounts if they need it and (b) are able to buy
good insurance on the same terms that those of us who are insured by Government
or larger businesses can.
Now it seems to me that is a fair and simple and obvious way to do this. I
think that any other way will sooner or later involve either a radical change,
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FOCUS
that is, getting rid of the whole health insurance market and substituting taxes
for it, or involve people who are already paying too much for their own health
care, having to pay something for people who won't do anything for themselves
because they say they should be exempt.
Now I think that this is a very important issue. You know, again, we lose
sight of the fact that most small businesses are making an effort to cover their
employees. We have brought hundreds and hundreds of small businesses to
Washington to talk to the Congress, but they are not organized. There is no
association called: small businesses who cover their employees and are mad their
competitors don't and mad they can't get better insurance rates [laughter]
and wish somebody would help them. So an association that may have a lot of
folks in the insurance industry, along with other small businesses, says, "Don't
do this; the whole small business economy will break," says this, and there's no
association on the other side. You have to be their voice.
Had a car dealer from a town of 7,000 people in Arkansas up staying with me
the other night, he and his wife, long-time friends of mine. She's a college
teacher. He's a car dealer. He said to me the other night -- it was funny
he said, "You know, for 20 years I have been feeling sorry for myself because
I've provided a good health plan for my employees, and none of my competitors
did." So he said, "I was so happy when you proposed this just because I thought
I was going to get even." [Laughter] And then he said, "But you know, then I
remembered that in the last 20 years I put three of my competitors out of
business. And I'm making more money than I ever have. And the reason is I
still got the same folks working for me I had 20 years ago because I gave them
health benefits."
And yesterday I went to New York and I visited this Pathmark store. They
have 175 stores, 28,000 employees, the 10th biggest supermarket chain in the
country. We're all told, "Oh, if you do this, the retailing business will go to
pieces. These people have put new stores in inner-city areas that other chains
would not touch, fine new stores. They are making money, and they have always
provided comprehensive health benefits to their employees. And they are now
sacking their groceries in a bag that says they favor health care benefits to
all Americans, guaranteed through the workplace.
I say this to you because, as you know, there are a lot of nurses that don't
have any health care coverage and a lot of nurses who are single parents who
don't have health care coverage. And this is the other point I want to make
that I did to all those young people working in that grocery store yesterday:
Everybody now in Washington is for welfare reform, and I guess it means
different things to different people. But I have basically a 3-point strategy
to achieve what I think would end the welfare system as we know it: One was
embodied in last year's economic plan, lower income taxes for working people who
are hovering just above the poverty line with children. This year one in six
American working families will be eligible for lower income taxes so they can
succeed at work and can succeed as parents.
Strategy number two, give people education and training and then give them a
certain amount of time to find a job. And if they don't, require them to take
it. And if they can't, provide some public subsidy in the private sector or
some publicly funded job SO that work is preferable to welfare.
Page 9
Public Papers of the Presidents
FOCUS
Strategy number three has got to be cover the people with health insurance.
Consider this: All these people on welfare in this country who are dying to
get off and by the way, that's most of them who are dying to get off,
most
of them have limited education. Suppose they go through a little training
program and they get a job that pays a modest wage but is still more than the
welfare benefits. But they go to work for an employer who does not provide for
health care.
Think about this: You are a mother with two children. You give up being on
welfare to take a job that pays more than the welfare check, but you lose health
care coverage for your kids. What are you going to do if your kid has to go to
the dentist? What are you going to do if your child is desperately ill? How
are you going to feel every week, every 2 weeks or every month when you get your
paycheck and you see what's taken out of it in taxes and you realize those taxes
are going to pay for the health care benefits of people who decided to stay on
welfare instead of going to work? You don't have to be as bright as a tree full
of owls to figure out that this doesn't make a lot of sense. [Laughter]
Now a lot of American nurses are in this situation today, getting up every
day, slaving away, trying to take care of people who have children without
insurance, caring for people who come into their office who are on public
assistance who have children with insurance because of the Medicaid program. It
is not fair. It is not right. It is not smart.
And you could say, "Well, all this inability to cover everybody, if this were
fueling some enormous American economic expansion, because we were saving SO
much money on health care, maybe you could deal with that. But the truth is
we're spending over 40 percent more of our income on health care than any other
country in the world. Oh yes, some of it because we're more violent, and that's
something we pay for. Some of it because we have better medical research and
technology, and that's worth paying for. But a whole lot of it, as you well
know, is because of the way we have financed health care, which has employed
hundreds of thousands of people in doctors' offices, in clinics, in hospitals,
and in insurance companies to read the fine print on thousands and thousands of
policies to see who and what is not covered. And it has rifled inefficiencies
through this system that we are all paying for.
We can fix this. We can fix it by having a law which fixes what's wrong,
keeps what's right, provides health care security to everybody through a private
system, increases the choices consumers have, and increases the decisions that
doctors and nurses and other qualified providers make without oversight by
others. We can do it.
In order to do it, we have to recognize we have to go through a fog of
misinformation, a torrent of labels which aren't right, and recognize, too, that
you have to lobby and stand up for, in an organized and very personal way, that
great association that doesn't exist, the association of 81 million Americans
and families with preexisting conditions, the association of hundreds of
thousands of small businesses who ate doing the fight thing and being punished
for it, the association of all the poor women in this country who are out there
working their hearts out and their fingers to the bone to do right by their kids
without health insurance and paying taxes for people on public assistance who
have it for their children. All of those associations are disorganized.
Page 10
Public Papers of the Presidents
FOCUS
You have devoted your lives to providing health care to all Americans. You
have honored my favorite nurse today. You have given me a chance to hope that
my mother and my grandmother are looking down on me thinking I was the first
generation in three that didn't produce anybody that was caring for other people
in health care. So they think at least I walked off with the award today.
[Laughter] It means more to me than I can say.
But the determination that my mother showed in getting up off the pavement
many times in her life is the same sort of determination you have to show for us
to get health care reform this year. And remember, most of these Members of
Congress want to do the right thing. But they don't know what you know; they
haven't spent the time that you've spent; they haven't had the experiences you
have had. You have to help them. And the people in their districts that really
need their help are not in those great national associations.
You keep them in your mind and keep that example in your mind. Don't let
this year go by. We can do this this year with your help and your leadership.
Thank you, and God bless you all.
NOTE: The President spoke at 9:56 a.m. in the Regency A Ballroom at the Hyatt
Regency. In his remarks, he referred to Virginia Trotter Betts, president,
American Nurses Association. A tape was not available for verification of the
content of these remarks.
LANGUAGE: ENGLISH
LOAD-DATE: June 08, 1994
Teny
REVISED THE PRESIDENT HAS SEEN
6.18.96
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
96 JUN 18 A10 42
THE PRESIDENT 6.18.96 HAS SEEN-
REVISED
[Acknowledgments: Ginna Trotter Betts -- she is
leaving after four years as national president of ANA.
She was a leading voice for health care reform.]
I am honored to join you in this 100th anniversary
celebration. Today, I ask all Americans to join me in
saluting you for a century of service and leadership.
America has the finest health care system in the world.
And nurses are the heart and soul of that system.
Bec. of my mooner,
Л I know the hard work and sacrifice that goes into
being a good nurse. As most of you know, for more
than 30 years, my mother worked as a nurse
anesthetist. I want to thank you again for honoring her
memory in 1994 with a special award in her name₅ and
fn all you des everyday.
2
I have vivid memories of her getting up in the
middle of the night to be at work by 7 a m. She was
serious about the life and death nature of her work.
But she understood that healing is about more than
medicine and technology It is also about promoting
good health and prevention. And it is about caring.
That is what all of you do everyday.
What I learned from my mother and what America
is learning from you are the basic values that make us
strong. We know that the mission of this country must
be to offer every American an opportunity and demand
that every American take responsibility -- that is the
basic bargain of our democracy. Oblig to that all
Amer who an respon w/ repect tolerauce
build strong convu. -3-> ? strong Aven
And that is how we will create an America that is
rooted in strong communities and strong families.
1
Econ:
2
Crim:
3
Ecl :
Today, I want to talk with you about how we can
4
work together to build strong families and to guarantee
that every child in this country has both quality health
care and the support of responsible parents -- both
mothers and fathers.
For the past three-and-a-half years, we have
worked hard to give people opportunity, by giving them
the tools they need to build strong families.
Heau
HRC
Tobacco
Docce View
HIULHIUS
- 4 -
Working with you, we fought for the Family and
Medical Leave Act to say that if you take a little time
off to take care of a sick child you will not lose your
job. There are some in Washington who to this day
oppose Family and Medical Leave But I think it was
the right thing to do, and I am proud to have signed it
into law.
Now, this Republican Congress seems to have
forgotten the first rule of health care: "First, do no
harm."
I am proud that, working with you, we fought to
preserve Medicaid.
- 5 -
For three decades, we have guaranteed that poor
children, pregnant women, people with disabilities and
older Americans will not be denied health care simply
because they can't afford it. That is the right thing to
do. The Republicans in Congress are actually insisting
that we repeal this guarantee. I have said that this
would amount to child neglect for a whole generation.
That is why I vetoed this plan last year when the
Republican Congress sent it to me. And let me assure
you, if they send it to me again, I will veto it again.
Working with you, we have fought to balance the
budget in a way that protects Medicare and honors our
duty to our parents.
- 6 -
The Republican proposal for Medicare would
undermine the hiring and training of nurses, and would
close down hospital wings in cities and rural
communities across America. We must reform
Medicare; my plan will secure the Trust Fund for a
decade. But we do not need to devastate Medicare to
balance the budget.
And while we are doing no harm, why don't we do
some good? We are working with you to improve
access to health care for as many as 25 million
Americans by fighting for the Kassebaum-Kennedy bill.
No worker in this country should have to worry that he
or she will lose their health care if they lose their job
or change jóbs.
- 7 -
And no one should be denied care simply because
cougress
they have a pre-existing condition.) N I challenge
Congress to work with us -to pass this important
legislation now.
And we should do another thing to help working
families. We should raise the minimum wage now.
We are doing all this to give our people
opportunity. But we must demand responsibility in
return. You and I know that, where children are
America &
concerned, the most important building block of/strong
is is
families is not government. It is parents -- mothers and
fathers who love their children and take active
responsibility for their care.
- 8 -
Parental responsibility has been the driving
principle behind our efforts to end welfare as we know
it. I want reform because our present system
perpetuates a cycle of dependency and irresponsible
behavior. Nobody wants welfare reform more than the
people who are trapped in the current system. I want a
system that promotes work, strengthens families, and
encourages independence. That is why I have proposed
time limits, work requirements, and child care and
health care to help people move from welfare to work.
That is real welfare reform.
This Congress sent me a bill that was tough on kids
and easy on work, and I sent it back and told them to
do better.
- 9 -
Meanutics
A My Administration will continue to reform welfare,
with or without help from Congress.
We have worked to cut red tape for 40 states by
approving 63 welfare reform experiments at the local
level. Just today, we approved a waiver for a welfare
reform effort in New Hampshire, which combines
strong work requirements with incentives to move
people from welfare to work. For 3 out of 4 welfare
informina
recipients,) the rules atture have changed. 1 have rec'd a projosal
to wise.
truits, gull worls Heavy celle
Expectto
ok soon,
I am proud that today, 1.3 million fewer people are
on welfare than when I took office.
- 10 -
The food stamp rolls are down, the poverty rate is
down, teen pregnancy rates are down, while work and
training among welfare recipients are up and child
support collections have reached a record high.
But we must do more to insist on parental
responsibility. Our welfare reform proposals are about
giving people opportunity and demanding responsibility
in return. And I reject the idea that only the
mother has to act responsibly. Every child has both a
mother and a father. And for too long, we have let
men off the hook. We must insist that they do their
part to support the children they helped bring into this
world.
- 11 -
How many times have you seen a frightened young
girl give birth to a baby alone in the hospital, with the
father of the child no where to be found? How many
times has the hospital and the government been left to
pay the costs, not only for the delivery but for the
continuing care of that child? That is wrong. It takes
two people to bring a child into this world, and it takes
two people to raise that child.
That is why we have made it our mission to make
sure that parents take responsibility by supporting their
children. Last year, I signed an executive order that
cracked down on federal employees who owe child
support.
- 12 -
And 3 years ago I signed a law requiring states to
establish hospital-based programs to determine the
father of a newborn child. Based on our first reports,
more than 200,000 fathers have been identified through
these voluntary hospital paternity identification
programs last year. That's 200,000 children whose
fathers can't just up and walk away without a trace.
And child support collections and paternity
establishment are both up 40% since 1992.
But we have to do more. That is why earlier today,
I took executive action to strengthen child support
enforcement and promote parental responsibility.
- 13 -
First, we are putting in place a new national
program to help states track parents who owe child
support across state lines. Today, too many men have
figured out that the way to weasel get out of paying child
support is to move from job to job and state to state.
This must stop. Currently, twenty-five states require
that when a person is hired for a job, a check is made
to see if he owes child support. Under this new
program, we will check that information against our
national database to catch deadbeats who have crossed
state lines. And I challenge every state to give us this
information so that deadbeat dads have nowhere to
hide.
- 14 -
Second, today I directed the Department of Health
and Human Services to require all mothers who apply
for welfare to provide the name of the father and other
identifying information at the time they apply for
assistance, before they can get welfare benefits. There
will be "good cause" exceptions, such as to protect
Mother
women from the dangers of violence against women.
And we will require the welfare office to contact child
support authorities within two days to begin legal
proceedings to hold the father responsible for support.
- 15 -
Our system ought to say to mothers: If you
want our help, help us identify and locate the father
so we can hold him accountable. And it should say
to fathers -- we are not going to let you walk away
from your children and stick the taxpayers with the
tab. The government did not bring that child into
the world -- you did. My actions today help make
responsibility a way of life, not an option.
If we do all these things -- if we offer opportunity
by providing health care and family leave
if we
demand responsibility of fathers and mothers who bring
children into this world -- then we can restore our
social fabric and protect the American family.
- 16 -
You are on the front lines, every day, caring for
our children and our parents. Our nation owes it to
you to give you all the help you need. For all the
professionalism and compassion you pour into every
hour of every day, we thank you.
Thank you and God bless you all.
- 17 -
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
[Acknowledgments: Ginna Trotter Betts -- she is
leaving after four years as national president of ANA.
She was a leading voice for health care reform.]
I am honored to join you in this 100th anniversary
celebration. Today, I ask all Americans to join me in
saluting you for a century of service and leadership.
America has the finest health care system in the world.
And nurses are the heart and soul of that system.
I know the hard work and sacrifice that goes into
being a good nurse. As most of you know, for more
than 30 years, my mother worked as a nurse
anesthetist. I want to thank you again for honoring her
memory in 1994 with a special award in her name.
- 2 -
I have vivid memories of her getting up in the
middle of the night to be at work by 7 a.m. She was
serious about the life and death nature of her work.
But she understood that healing is about more than
medicine and technology. It is also about promoting
good health and prevention. And it is about caring.
That is what all of you do everyday.
What I learned from my mother and what America
is learning from you are the basic values that make us
strong. We know that the mission of this country must
be to offer every American an opportunity and demand
that every American take responsibility -- that is the
basic bargain of our democracy.
- 3 -
And that is how we will create an America that is
rooted in strong communities and strong families.
Today, I want to talk with you about how we can
work together to build strong families and to guarantee
that every child in this country has both quality health
care and the support of responsible parents -- both
mothers and fathers.
For the past three-and-a-half years, we have
worked hard to give people opportunity, by giving them
the tools they need to build strong families.
- 4 -
Working with you, we fought for the Family and
Medical Leave Act to say that if you take a little time
off to take care of a sick child you will not lose your
job. There are some in Washington who to this day
oppose Family and Medical Leave But I think it was
the right thing to do, and I am proud to have signed it
into law.
Now, this Republican Congress seems to have
forgotten the first rule of health care: "First, do no
harm."
I am proud that, working with you, we fought to
preserve Medicaid.
- 5 -
For three decades, we have guaranteed that poor
children, pregnant women, people with disabilities and
older Americans will not be denied health care simply
because they can't afford it. That is the right thing to
do. The Republicans in Congress are actually insisting
that we repeal this guarantee. I have said that this
would amount to child neglect for a whole generation.
That is why I vetoed this plan last year when the
Republican Congress sent it to me. And let me assure
you, if they send it to me again, I will veto it again.
Working with you, we have fought to balance the
budget in a way that protects Medicare and honors our
duty to our parents.
- 6 -
The Republican proposal for Medicare would
undermine the hiring and training of nurses, and would
close down hospital wings in cities and rural
communities across America. We must reform
Medicare; my plan will secure the Trust Fund for a
decade. But we do not need to devastate Medicare to
balance the budget.
And while we are doing no harm, why don't we do
some good? We are working with you to improve
access to health care for as many as 25 million
Americans by fighting for the Kassebaum-Kennedy bill.
No worker in this country should have to worry that he
or she will lose their health care if they lose their job
or change jobs.
- 7 -
And no one should be denied care simply because
they have a pre-existing condition. I challenge
Congress to work with us to pass this important
legislation now.
And we should do another thing to help working
families. We should raise the minimum wage now.
We are doing all this to give our people
opportunity. But we must demand responsibility in
return. You and I know that, where children are
concerned, the most important building block of strong
families is not government. It is parents -- mothers and
fathers who love their children and take active
responsibility for their care.
- 8 -
Parental responsibility has been the driving
principle behind our efforts to end welfare as we know
it. I want reform because our present system
perpetuates a cycle of dependency and irresponsible
behavior. Nobody wants welfare reform more than the
people who are trapped in the current system. I want a
system that promotes work, strengthens families, and
encourages independence. That is why I have proposed
time limits, work requirements, and child care and
health care to help people move from welfare to work.
That is real welfare reform.
This Congress sent me a bill that was tough on kids
and easy on work, and I sent it back and told them to
do better.
- 9 -
My Administration will continue to reform welfare,
with or without help from Congress.
We have worked to cut red tape for 40 states by
approving 63 welfare reform experiments at the local
level. Just today, we approved a waiver for a welfare
reform effort in New Hampshire, which combines
strong work requirements with incentives to move
people from welfare to work. For 3 out of 4 welfare
recipients, the rules have changed.
I am proud that today, 1.3 million fewer people are
on welfare than when I took office.
- 10 -
The food stamp rolls are down, the poverty rate is
down, teen pregnancy rates are down, while work and
training among welfare recipients are up and child
support collections have reached a record high.
But we must do more to insist on parental
responsibility. Our welfare reform proposals are about
giving people opportunity and demanding responsibility
in return. And I reject the idea that only the
mother has to act responsibly. Every child has both a
mother and a father. And for too long, we have let
men off the hook. We must insist that they do their
part to support the children they helped bring into this
world.
- 11 -
How many times have you seen a frightened young
girl give birth to a baby alone in the hospital, with the
father of the child no where to be found? How many
times has the hospital and the government been left to
pay the costs, not only for the delivery but for the
continuing care of that child? That is wrong. It takes
two people to bring a child into this world, and it takes
two people to raise that child.
That is why we have made it our mission to make
sure that parents take responsibility by supporting their
children. .Last year, I signed an executive order that
cracked down on federal employees who owe child
support.
- 12 -
And 3 years ago I signed a law requiring states to
establish hospital-based programs to determine the
father of a newborn child. Based on our first reports,
more than 200,000 fathers have been identified through
these voluntary hospital paternity identification
programs last year. That's 200,000 children whose
fathers can't just up and walk away without a trace.
And child support collections and paternity
establishment are both up 40% since 1992.
But we have to do more. That is why earlier today,
I took executive action to strengthen child support
enforcement and promote parental responsibility.
- 13 -
First, we are putting in place a new national
program to help states track parents who owe child
support across state lines. Today, too many men have
figured out that the way to weasel out of paying child
support is to move from job to job and state to state.
This must stop. Currently, twenty-five states require
that when a person is hired for a job, a check is made
to see if he owes child support. Under this new
program, we will check that information against our
national database to catch deadbeats who have crossed
state lines. And I challenge every state to give us this
information so that deadbeat dads have nowhere to
hide.
- 14 -
Second, today I directed the Department of Health
and Human Services to require all mothers who apply
for welfare to provide the name of the father and other
identifying information at the time they apply for
assistance, before they can get welfare benefits. There
will be "good cause" exceptions, such as to protect
women from the dangers of violence against women.
And we will require the welfare office to contact child
support authorities within two days to begin legal
proceedings to hold the father responsible for support.
- 15 -
Our system ought to say to mothers: If you
want our help, help us identify and locate the father
so we can hold him accountable. And it should say
to fathers -- we are not going to let you walk away
from your children and stick the taxpayers with the
tab. The government did not bring that child into
the world -- you did. My actions today help make
responsibility a way of life, not an option.
If we do all these things -- if we offer opportunity
by providing health care and family leave
if we
demand responsibility of fathers and mothers who bring
children into this world -- then we can restore our
social fabric and protect the American family.
- 16 -
You are on the front lines, every day, caring for
our children and our parents. Our nation owes it to
you to give you all the help you need. For all the
professionalism and compassion you pour into every
hour of every day, we thank you.
Thank you and God bless you all.
- 17 -
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
[Acknowledgments: Ginna Trotter Betts -- she is leaving after four years as national
president of ANA. She was a leading voice for health care reform.]
I am honored to join you in this 100th anniversary celebration. Today, I ask all
Americans to join me in saluting you for a century of service and leadership. America has
the finest health care system in the world. And nurses are the heart and soul of that system.
I know the hard work and sacrifice that goes into being a good nurse. As most of
you know, for more than 30 years, my mother worked as a nurse anesthetist. I want to
thank you again for honoring her memory in 1994 with a special award in her name. I have
vivid memories of her getting up in the middle of the night to be at work by 7 a.m. She was
serious about the life and death nature of her work. But she understood that healing is
about more than medicine and technology. It is also about promoting good health and
prevention. And it is about caring. That is what all of you do everyday.
What I learned from my mother and what America is learning from you are the basic
values that make us strong. We know that the mission of this country must be to offer every
American an opportunity and demand that every American take responsibility -- that is the
basic bargain of our democracy. And that is how we will create an America that is rooted in
strong communities and strong families.
Today, I want to talk with you about how we can work together to build strong
families and to guarantee that every child in this country has both quality health care and the
support of responsible parents -- both mothers and fathers.
For the past three-and-a-half years, we have worked hard to give people opportunity,
by giving them the tools they need to build strong families.
Working with you, we fought for the Family and Medical Leave Act to say that if
you take a little time off to take care of a sick child you will not lose your job. There are
some in Washington who to this day oppose Family and Medical Leave But I think it was
the right thing to do, and I am proud to have signed it into law.
Now, this Republican Congress seems to have forgotten the first rule of health care:
"First, do no harm."
I am proud that, working with you, we fought to preserve Medicaid. For three
decades, we have guaranteed that poor children, pregnant women, people with disabilities
and older Americans will not be denied health care simply because they can't afford it. That
1
is the right thing to do. The Republicans in Congress are actually insisting that we repeal
this guarantee. I have said that this would amount to child neglect for a whole generation.
That is why I vetoed this plan last year when the Republican Congress sent it to me. And let
me assure you, if they send it to me again, I will veto it again.
Working with you, we have fought to balance the budget in a way that protects
Medicare and honors our duty to our parents. The Republican proposal for Medicare would
undermine the hiring and training of nurses, and would close down hospital wings in cities
and rural communities across America. We must reform Medicare; my plan will secure the
Trust Fund for a decade. But we do not need to devastate Medicare to balance the budget.
And while we are doing no harm, why don't we do some good? We are working
with you to improve access to health care for as many as 25 million Americans by fighting
for the Kassebaum-Kennedy bill. No worker in this country should have to worry that he or
she will lose their health care if they lose their job or change jobs. And no one should be
denied care simply because they have a pre-existing condition. I challenge Congress to work
with us to pass this important legislation now.
And we should do another thing to help working families. We should raise the
minimum wage now.
We are doing all this to give our people opportunity. But we must demand
responsibility in return. You and I know that, where children are concerned, the most
important building block of strong families is not government. It is parents -- mothers and
fathers who love their children and take active responsibility for their care.
Parental responsibility has been the driving principle behind our efforts to end welfare
as we know it. I want reform because our present system perpetuates a cycle of dependency
and irresponsible behavior. Nobody wants welfare reform more than the people who are
trapped in the current system. I want a system that promotes work, strengthens families, and
encourages independence. That is why I have proposed time limits, work requirements, and
child care and health care to help people move from welfare to work. That is real welfare
reform.
This Congress sent me a bill that was tough on kids and easy on work, and I sent it
back and told them to do better. My Administration will continue to reform welfare, with or
without help from Congress.
We have worked to cut red tape for 40 states by approving 63 welfare reform
experiments at the local level. Just today, we approved a waiver for a welfare reform effort
in New Hampshire, which combines strong work requirements with incentives to move
people from welfare to work. For 3 out of 4 welfare recipients, the rules have changed.
I am proud that today, 1.3 million fewer people are on welfare than when I took
2
office. The food stamp rolls are down, the poverty rate is down, teen pregnancy rates are
down, while work and training among welfare recipients are up and child support collections
have reached a record high.
But we must do more to insist on parental responsibility. Our welfare reform
proposals are about giving people opportunity and demanding responsibility in return. And I
reject the idea that only the mother has to act responsibly. Every child has both a mother
and a father. And for too long, we have let men off the hook. We must insist that they do
their part to support the children they helped bring into this world.
How many times have you seen a frightened young girl give birth to a baby alone in
the hospital, with the father of the child no where to be found? How many times has the
hospital and the government been left to pay the costs, not only for the delivery but for the
continuing care of that child? That is wrong. It takes two people to bring a child into this
world, and it takes two people to raise that child.
That is why we have made it our mission to make sure that parents take responsibility
by supporting their children. Last year, I signed an executive order that cracked down on
federal employees who owe child support. And 3 years ago I signed a law requiring states to
establish hospital-based programs to determine the father of a newborn child. Based on our
first reports, more than 200,000 fathers have been identified through these voluntary hospital
paternity identification programs last year. That's 200,000 children whose fathers can't just
up and walk away without a trace. And child support collections and paternity establishment
are both up 40% since 1992.
But we have to do more. That is why earlier today, I took executive action to
strengthen child support enforcement and promote parental responsibility.
First, we are putting in place a new national program to help states track parents who
owe child support across state lines. Today, too many men have figured out that the way to
weasel out of paying child support is to move from job to job and state to state. This must
stop. Currently, twenty-five states require that when a person is hired for a job, a check is
made to see if he owes child support. Under this new program, we will check that
information against our national database to catch deadbeats who have crossed state lines.
And I challenge every state to give us this information so that deadbeat dads have nowhere to
hide.
Second, today I directed the Department of Health and Human Services to require all
mothers who apply for welfare to provide the name of the father and other identifying
information at the time they apply for assistance, before they can get welfare benefits. There
will be "good cause" exceptions, such as to protect women from the dangers of violence
against women. And we will require the welfare office to contact child support authorities
within two days to begin legal proceedings to hold the father responsible for support.
3
Our system ought to say to mothers: If you want our help, help us identify and
locate the father so we can hold him accountable. And it should say to fathers -- we are
not going to let you walk away from your children and stick the taxpayers with the tab.
The government did not bring that child into the world -- you did. My actions today
help make responsibility a way of life, not an option.
If we do all these things -- if we offer opportunity by providing health care and
family leave
if we demand responsibility of fathers and mothers who bring children into
this world -- then we can restore our social fabric and protect the American family.
You are on the front lines, every day, caring for our children and our parents. Our
nation owes it to you to give you all the help you need. For all the professionalism and
compassion you pour into every hour of every day, we thank you.
Thank you and God bless you all.
4
PRESIDENT WILLIAM J. CLINTON
AMERICAN NURSES ASSOCIATION
WASHINGTON, DC
JUNE 18, 1996
[Acknowledgments: Ginna Trotter Betts -- she is leaving after four years as national
president of ANA. 'She was a leading voice for health care reform.]
I am honored to join you in this 100th anniversary celebration. Today, I ask all
Americans to join me in saluting you for a century of service and leadership. America has
the finest health care system in the world. And nurses are the heart and soul of that system.
I know the hard work and sacrifice that goes into being a good nurse. As most of
you know; for more than 30 years, my mother worked as a nurse anesthetist. I want to
thank you again for honoring her memory in 1994 with a special award in her name. I have
vivid memories of her getting up in the middle of the night to be at work by 7 a.m. She was
serious about the life and death nature of her work. But she understood that healing is
about more than medicine and technology. It is also about promoting good health and
prevention. And it is about caring. That is what all of you do everyday.
What I learned from my mother and what America is learning from you are the basic
values that make us strong. We know that the mission of this country must be to offer every
American an opportunity and demand that every American take responsibility -- that is the
basic bargain of our democracy. And that is how we will create an America that is rooted in
strong communities and strong families.
Today, I want to talk with you about how we can work together to build strong
families and to guarantee that every child in this country has both quality health care and the
support of responsible parents -- both mothers and fathers.
For the past three-and-a-half years, we have worked hard to give people opportunity,
by giving them the tools they need to build strong families.
Working with you, we fought for the Family and Medical Leave Act to say that if
you take a little time off to take care of a sick child you will not lose your job. There are
some in Washington who to this day oppose Family and Medical Leave But I think it was
the right thing to do, and I am proud to have signed it into law.
Now, this Republican Congress seems to have forgotten the first rule of health care:
"First, do no harm."
I am proud that, working with you, we fought to preserve Medicaid. For three
decades, we have guaranteed that poor children, pregnant women, people with disabilities
and older Americans will not be denied health care simply because they can't afford it. That
is the right thing to do. The Republicans in Congress are actually insisting that we repeal
this guarantee. I have said that this would amount to child neglect for a whole generation.
That is why I vetoed this plan last year when the Republican Congress sent it to me. And let
me assure you, if they send it to me again, I will veto it again.
Working with you, we have fought to balance the budget in a way that protects
Medicare and honors our duty to our parents. The Republican proposal for Medicare would
undermine the hiring and training of nurses, and would close down hospital wings in cities
and rural communities across America. We must reform Medicare; my plan will secure the
Trust Fund for a decade. But we do not need to devastate Medicare to balance the budget.
And while we are doing no harm, why don't we do some good? We are working
with you to improve access to health care for as many as 25 million Americans by fighting
for the Kassebaum-Kennedy bill. No worker in this country should have to worry that he or
she will lose their health care if they lose their job or change jobs. And no one should be
denied care simply because they have a pre-existing condition. I challenge Congress to work
with us to pass this important legislation now.
And we should do another thing to help working families. We should raise the
minimum wage now.
We are doing all this to give our people opportunity. But we must demand
responsibility in return. You and I know that, where children are concerned, the most
important building block of strong families is not government. It is parents -- mothers and
fathers who love their children and take active responsibility for their care.
Parental responsibility has been the driving principle behind our efforts to end welfare
as we know it. I want reform because our present system perpetuates a cycle of dependency
and irresponsible behavior. Nobody wants welfare reform more than the people who are
trapped in the current system. I want a system that promotes work, strengthens families, and
encourages independence. That is why I have proposed time limits, work requirements, and
child care and health care to help people move from welfare to work. That is real welfare
reform.
This Congress sent me a bill that was tough on kids and easy on work, and I sent it
back and told them to do better. My Administration will continue to reform welfare, with or
without help from Congress.
We have worked to cut red tape for 40 states by approving 63 welfare reform
experiments at the local level. Just today, we approved a waiver for a welfare reform effort
in New Hampshire, which combines strong work requirements with incentives to move
people from welfare to work. For 3 out of 4 welfare recipients, the rules have changed.
I am proud that today, 1.3 million fewer people are on welfare than when I took
2
office. The food stamp rolls are down, the poverty rate is down, teen pregnancy rates are
down, while work and training among welfare recipients are up and child support collections
have reached a record high.
But we must do more to insist on parental responsibility. Our welfare reform
proposals are about giving people opportunity and demanding responsibility in return. And I
reject the idea that only the mother has to act responsibly. Every child has both a mother
and a father. And for too long, we have let men off the hook. We must insist that they do
their part to support the children they helped bring into this world.
How many times have you seen a frightened young girl give birth to a baby alone in
the hospital, with the father of the child no where to be found? How many times has the
hospital and the government been left to pay the costs, not only for the delivery but for the
continuing care of that child? That is wrong. It takes two people to bring a child into this
world, and it takes two people to raise that child.
That is why we have made it our mission to make sure that parents take responsibility
by supporting their children. Last year, I signed an executive order that cracked down on
federal employees who owe child support. And 3 years ago I signed a law requiring states to
establish hospital-based programs to determine the father of a newborn child. Based on our
first reports, more than 200,000 fathers have been identified through these voluntary hospital
paternity identification programs last year. That's 200,000 children whose fathers can't just
up and walk away without a trace. And child support collections and paternity establishment
are both up 40% since 1992.
But we have to do more. That is why earlier today, I took executive action to
strengthen child support enforcement and promote parental responsibility.
First, we are putting in place a new national program to help states track parents who
owe child support across state lines. Today, too many men have figured out that the way to
weasel out of paying child support is to move from job to job and state to state. This must
stop. Currently, twenty-five states require that when a person is hired for a job, a check is
made to see if he owes child support. Under this new program, we will check that
information against our national database to catch deadbeats who have crossed state lines.
And I challenge every state to give us this information so that deadbeat dads have nowhere to
hide.
Second, today I directed the Department of Health and Human Services to require all
mothers who apply for welfare to provide the name of the father and other identifying
information at the time they apply for assistance, before they can get welfare benefits. There
will be "good cause" exceptions, such as to protect women from the dangers of violence
against women. And we will require the welfare office to contact child support authorities
within two days to begin legal proceedings to hold the father responsible for support.
3
Our system ought to say to mothers: If you want our help, help us identify and
locate the father SO we can hold him accountable. And it should say to fathers -- we are
not going to let you walk away from your children and stick the taxpayers with the tab.
The government did not bring that child into the world -- you did. My actions today
help make responsibility a way of life, not an option.
If we do all these things -- if we offer opportunity by providing health care and
family leave
if we demand responsibility of fathers and mothers who bring children into
this world -- then we can restore our social fabric and protect the American family.
You are on the front lines, every day, caring for our children and our parents. Our
nation owes it to you to give you all the help you need. For all the professionalism and
compassion you pour into every hour of every day, we thank you.
Thank you and God bless you all.
4
EXECUTIVE OFFICE OF THE PRESIDE
17-Jun-1996 18pm
TO:
James T. Edmonds
TO:
Rahm Emanuel
FROM:
Mary A. Dixon
Office of Public Liaison
SUBJECT:
From Betsy Myers
Proposed Language for ANA
puchas
We will have exceptions for mothers with "good cause, which
would include protecting their health and safety in cases of rape
and incest and when women are escaping domestic violence. Our
action will strengthen child support enforcement but not at the
risk of placing women in danger.
health safety
being
There will be good Cause
exceptions especially such
asbeing Kindanger of domets wiolence
to pretect a woman
Apiniture
Helly Carver
sohold so 62983 hold 67936
CHURCH FIRES MEETING
JUNE 17, 1996
Governors' Meeting
likely attendees
draft agenda
briefing materials
agency rehearsal
Private sector efforts
Legislation
Treasury supplemental
HUD piece