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Date: August 4, 1998
FACT SHEET
Contact: HHS Press Office (202) 690-6343
HHS Invests in America's Children
Overview: Our nation's future depends on the healthy growth and development of our
children. At the Department of Health and Human Services, Secretary Donna E. Shalala
has developed a multifaceted strategy to promote the positive development of our
young people, especially disadvantaged children.
The HHS strategy focuses on two broad areas - "Strong Foundations" for young
children and families, and "Safe Passages" for older children and teens. During early
childhood, healthy development is the foundation for a healthy life, and HHS supports
services that help families achieve this goal. During their teen years, children need
social and community supports to navigate a safe passage from adolescence to
adulthood.
Since 1993, HHS has significantly increased investments in priority areas for children,
and results have followed. For example, a record number of 2-year-olds are now
properly vaccinated, while most vaccine-preventable diseases are at record lows. In the
Head Start program, enrollment is up, younger children are being served, and quality is
improving.
To improve child health and access to health care, in 1997 the President proposed and
Congress passed the Children's Health Insurance Program (CHIP). The program sets
aside $24 billion over five years for states to provide new health coverage for uninsured
children. In addition, states can use part of their federal funds to expand outreach and
ensure that all children eligible for Medicaid and CHIP are enrolled.
In welfare reform, President Clinton signed a welfare bill that is helping more families
move from welfare to work and self-sufficiency, while protecting children with supports
like transitional health coverage and increased investments in child care. The new
welfare law also includes sweeping child support enforcement measures proposed by
President Clinton, which are substantially increasing collections from absent parents.
Welfare reform has also increased child care funding by $3.5 billion over six years,
allowing more mothers to leave Welfare for work or to avoid Welfare altogether.
HHS is also creating new partnerships in the public and private sectors to promote
children's well-being. For example, in November 1996, HHS launched "Girl Power!,"
an initiative bringing together parents, schools, communities, religious organizations,
health providers, and other caring adults to help reinforce 9 to 14 year old girls'
self-confidence through positive messages, meaningful opportunities, and accurate
information about key health issues.
MAJOR HHS PROGRAMS SERVING CHILDREN
One of HHS' highest priorities is serving children and teens who are disadvantaged. The
Department's programs form a safety net, and launching pad, for these children. HHS
programs for children in need serve about one in every five children in America. In addition,
all children, youth and families are served by broad-based research supported by HHS.
Major HHS programs serving children include:
MEDICAID:
HHS child-related spending in FY 1998: $20 billion Estimated children served: 18 million
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF):
HHS spending in FY 1998: $16.7 billion Estimated children served: 6 million
FOSTER CARE & ADOPTION ASSISTANCE:
HHS spending in FY 1998: $4.3 billion Estimated children served: 475,000
HEAD START:
HHS spending in FY 1998: $4.4 billion Estimated children served: 830,000
CHILD CARE PROGRAMS:
HHS spending in FY 1998: $3.1 billion Estimated children served: 1 million
Other HHS investments for children and youth include: FY 1998 Child support enforcement
$2.7 billion Immunization $844 million Social services programs $5.7 billion Youth programs
$73 million
YOUNG CHILDREN: "STRONG FOUNDATIONS"
EXPANDING ACCESS TO HEALTH CARE
Because more than 10 million American children-- one in seven-- lacked health insurance,
President Clinton has put extending health coverage to more children at the top of his term
agenda.
Children's Health Insurance Program. The number of children lacking health insurance has risen
from 9.9 million in 1995 to 10.6 in 1996. To help address this current problem, the Children's Health
Insurance Program (CHIP) was launched as part of the Balanced Budget Act of 1997. The
legislation sets aside $24 billion over five years for states to provide new health coverage for millions
of children-- the largest children's health care investment since the creation of Medicaid in 1965.
The program's goal is to cover children who are uninsured because (1) their parents' employers don't
cover them; (2) their parents earn too much to qualify for Medicaid, but not enough to afford private
insurance; or (3) they are eligible for Medicaid but not enrolled. States creating new health insurance
programs must have those programs approved by the Secretary of Health and Human Services
before they can draw down their state allotments. As of July 1998, 26 Children's Health Insurance
plans had been approved.
The Health Insurance Portability and Accountability Act of 1996. On August 21, 1996,
President Clinton signed into law the Health Insurance Portability and Accountability Act of 1996,
which includes important new protections for an estimated 25 million Americans (approximately 1 in
10) who move from one job to another, who are self-employed, or who have pre-existing medical
conditions. It is designed to improve the availability of health insurance to working families and their
children.
State Medicaid Demonstrations. Since January 1993, HHS has approved 18 comprehensive
health care reform demonstration projects. When fully implemented, these demonstration projects
will extend health care coverage to 2.2 million Americans who would not have otherwise had
coverage. In addition, 19 states have received Medicaid waivers since January 1993, as part of
larger welfare reform projects; and 25 local Medicaid demonstration projects have been approved,
affecting smaller components of state Medicaid programs.
Maternal and Child Health Services Block Grant. Title V of the Social Security Act awarded
$683 million in block grants to individual states for FY 1998. Title V is administered by Health
Resources and Services Administration's Maternal and Child Health Bureau.
REDUCING INFANT MORTALITY
Thanks to an intensified national commitment to giving babies a healthy start in life, the U.S.
infant mortality rate, which is the rate at which babies die before their first birthday, is at an
historic low of 7.2 deaths per 1,000 live births in 1996, and the proportion of mothers getting
early prenatal care is at a record high of 82 percent. The infant mortality rate has dropped 17
percent since 1990. We've also seen declines in some of the risk factors for low birth weight
and infant mortality: teen births dropped for the fifth straight year in 1996 and smoking
among pregnant women has been decreasing in recent years. Nevertheless, the United States
continues to have unacceptably high infant mortality rates with significant disparities among
racial and ethnic groups. HHS has several initiatives to reduce infant mortality:
Healthy Start. The Healthy Start Initiative, administered by the Health Resources and Services
Administration (HRSA), reaches out to high-risk women and families in 60 communities reporting
high infant mortality rates, and builds local community partnerships to serve them. FY 1998 spending
was $94 million.
First-Ever Prenatal Care Hotline. To further help assure that women have proper prenatal care,
HHS announced in February 1997 the first nationwide toll-free referral and information service to
help women obtain proper prenatal care throughout their pregnancies. Under the program, callers in
all 50 states can telephone 1-800-31 1 -BABY (2229) for pregnancy and prenatal care information,
including referral to local clinics and physicians. A separate phone number is available for Spanish
speakers: 1-800-504-7081. The new service is supported by HRSA's Healthy Start program.
Research. HHS supports medical research through the National Institutes of Health (NIH), the
Centers for Disease Control and Prevention (CDC) and other agencies to prevent birth defects,
premature birth, Sudden Infant Death Syndrome (SIDS), Fetal Alcohol Syndrome and other
life-threatening conditions. Efforts by CDC and NIH created the groundwork for the decision in
February 1996 by the FDA to fortify foods with folic acid to ensure that women have sufficient
amounts of the vitamin shortly before and during early pregnancy. Folic acid, or folate, reduces the
risk of neural tube birth defects such as spina bifida when consumed in adequate amounts by women
before and during early pregnancy.
Back to Sleep Campaign. The National Institute of Child Health and Human Development
(NICHD), part of the National Institutes of Health, launched the public-private Back to Sleep
campaign in 1994 to amplify the message that back sleeping can reduce the risk of SIDS and save
lives. Largely due to the increase in awareness produced by the Back to Sleep campaign, SIDS
deaths declined by nearly 40 percent between 1992 and 1996. In March 1997, Tipper Gore began
leading an expanded Back to Sleep effort designed to reach a larger audience of caregivers and to
reach populations at high risk for SIDS.
EXPANDING AND IMPROVING HEAD START
Head Start is America's premier early childhood development program. Giving a boost to
children's education and helping strengthen the skills of parents to better nurture and provide
their children, Head Start is making a significant difference in the lives of children and
families. With bipartisan support from Congress, President Clinton has made the expansion
and improvement of Head Start a top priority for his Administration.
Increased Funding. Under the Clinton Administration, funding for Head Start has nearly doubled,
increasing from $2.2 billion in FY 1992 to $4.4 billion in FY 1998. These additional funds have
enabled Head Start to increase the number of children and families served by approximately 35
percent, enhance the quality of Head Start services, launch a new initiative to serve infants and
toddlers, and improve program research. In FY 1998, Head Start will serve an estimated 836,000
children and their families. President Clinton has committed his Administration to future funding
increases with a goal of serving one million children in Head Start by the year 2002. The President's
FY 1999 budget provides $4.7 billion for Head Start, which will enable the program to serve an
additional 30,000 to 36,000 children.
Early Head Start. The landmark Head Start Act Amendments of 1994 established the Early Head
Start program, which expands the benefits of early childhood development to low income families
with children under three and to pregnant women. Funding for FY 1998 totals $279 million, and the
FY 1999 budget includes $350 million, allowing the program to serve nearly 50,000 infants,
toddlers, and their families.
Assuring Head Start Quality. In November 1996, HHS published revised Head Start Program
Performance Standards, developed with the consultation of thousands in the Head Start field, that
improve on the program's existing quality standards. These revised, more user-friendly standards
remove rigid and prescriptive requirements, integrate infants and toddlers into the Head Start
program, and promote collaboration with other community programs. From 1992 through 1998,
HHS will have invested nearly $700 million in quality improvements to ensure that every Head Start
program works. Head Start programs across the country have used these quality resources to fix
leaky roofs, make sure facilities are healthy and safe for children, and hire more teachers to reduce
class size and eliminate double-session classes.
Head Start Full-Day, Full-Year Initiative. On March 25, 1997, Secretary Shalala announced a
new Head Start initiative to expand Head Start services for children while also helping parents on
welfare to move to work. Under the new initiative, Head Start expansion funds are used the first time
to build partnerships with child care providers to deliver full-day and full-year Head Start services.
Full-day and full-year services, in turn, can help parents attain full-time work.
INCREASING CHILDHOOD IMMUNIZATION
Childhood immunization was one of the earliest priorities of the Clinton Administration. In
response to disturbing gaps in the immunization rates for young children in America, the
Administration designed a comprehensive Childhood Immunization Initiative. This national
initiative addresses five areas:
1. Improving the quality and quantity of immunization services; 2. reducing vaccine costs for
parents; 3. increasing community participation, education and partnerships; 4. improving
systems for monitoring diseases and vaccinations; 5. improving vaccines and vaccine use.
Record Childhood Immunization Levels. Since 1993, childhood immunization rates have reached
all-time highs, with 90 percent or more of America's toddlers receiving the most critical doses of
most of the routinely recommended vaccines for children by age 2. In addition, reported levels of
disease were at or near record lows in 1996. Minority children, however, still lag behind white
children when overall vaccination rates are compared. While 79 percent of white children have
received the full series of vaccinations by age two, only 74 percent of African-American children and
71 percent of Hispanic children are fully vaccinated against childhood disease.
To help close these gaps, President Clinton announced a plan as part of the HHS Racial and Ethnic
Health Disparities Initiative to eliminate disparities in childhood immunization by 2010, including
interim goals for immediate progress. On April 20, 1998, HHS unveiled two new public awareness
campaigns designed to underscore to parents and caregivers the importance of all children receiving a
full course of recommended vaccinations by age two. The campaigns, one in English and one in
Spanish, feature print, radio, and television public service announcements.
Increased Funding. The Centers for Disease Control and Prevention manages the National
Childhood Immunization Initiative. The FY 1998 budget included $528 million for vaccine purchase
and $316 million for immunization program activities. In all, funding for childhood immunization has
increased by 147 percent since FY 1993.
New Regulations. On July 23, 1997, President Clinton proposed new child care regulations which
include a provision to help more children in child care receive the immunizations they need, on time.
The new rule requires that all children receiving federal child care assistance be immunized according
to State public health agency standards.
EXPANDING ACCESS TO CHILD CARE
On January 7, 1998, President Clinton proposed an historic investment in child care for America's
working families. The unprecedented $21.7 billion program would expand subsidies for low income
working families, increase tax credits for middle income families and provide resources to states and
communities to enhance and ensure that parents have quality choices in child care providers. The
President's plan gives parents flexible options to choose a child caretaker in their home, in a
neighborhood home or a center. There are about 10 million children eligible for federal subsidies, yet
as of 1995, only a little over 1 million children received support. With 70 percent of America's
mothers in the work force. the President's Proposal offers help providing for safe and healthy places
for their children for part of the day.
Increased Funding. The Personal Responsibility and Work Opportunity Reconciliation Act of
1996, signed into law by President Clinton, included $13.9 billion in mandatory child care funding --
an increase of $3.5 billion over six years -- allowing more mothers to leave welfare for work or avoid
welfare altogether. The law also authorized $7 billion in discretionary funding for FY's 1996-2002.
Overall, child care funding has increased by 80 percent since 1993.
Healthy Child Care America. Healthy Child Care America is an HHS initiative that promotes
partnerships between child care providers and health care services in projects in 48 states and
territories. HHS is in the final stages of funding the remaining states and territories. The purpose of the
initiative is to enhance health education for child care workers and parents, to support programs'
efforts to create healthy environments for children, and to better link programs with community health
resources.
ASSURING CHILD SUPPORT
President Clinton has made improving child support enforcement and increasing child support
collections a top priority. Since taking office, President Clinton has cracked down on
non-paying parents and strengthened child support enforcement, resulting in record child
support collections. In FY 1997, the federal-state partnership collected a record $13 billion
from non-custodial parents. an increase of $5 billion, or 63 percent, since 1992. The number
of families that are actually receiving child support has also increased: in 1997, the number of
child support cases with collections rose to 4.2 million, an increase of 48 percent from 2.8
million in 1992.
Increasing resources. President Clinton has proposed annual expansions in child support
enforcement, increasing resources by 53 percent since taking office. HHS has also launched an
initiative and given demonstration grants to states to promote improved performance, service quality
and public satisfaction in the child support program. The President's FY budget proposal allocates
$3.2 billion to state child support enforcement programs, a 17 percent increase over FY 1998.
Encouraging state innovations. In October 1997, HHS announced the award of $1.5 million in
demonstration grants to 17 states to support innovative projects to improve the nation's child support
enforcement program. In addition, in December 1997, HHS announced approval of a child support
waiver to allow the State of Washington to use federal funds normally used for child support
enforcement to fund "Devoted Dads," an innovative public/private partnership to promote the
responsible roles of fathers in the financial and emotional support of their children. The project, which
serves the Tacoma, Washington Enterprise Community, intends to reach non-custodial parents,
particularly young and at-risk fathers. This demonstration is the first child support waiver granted for
an enterprise community.
Executive Action. While working toward comprehensive improvement of child support
enforcement, President Clinton used his executive authority to increase child support collections. In
1996, President Clinton directed the Treasury Department to activate a centralized, streamlined
Federal system to offset child support debts against most Federal payments; ordered Federal
agencies to take necessary steps to deny loans, loan guarantees, or loan insurance to any individual
who is delinquent on child support debt; and issued an executive order to make the federal
government a model employer in the area of child support enforcement.
ADOPTION AND CHILD PROTECTION
With substantial increases in child abuse and neglect in America, states are confronting a
dramatic increase in foster care needs. The foster care caseload has grown from 340,000
cases in 1988 to 500,000 cases in 1996, an increase of 47 percent. The cost of the federal
foster care program, both in maintenance payments and administrative and training costs, has
grown from $891 million in 1988 to $3.7 billion in 1996, a 315 percent increase. The Clinton
Administration has provided an unprecedented level of technical assistance and local
flexibility to allow states to focus on outcomes and family preservation and adoption. As a
result, the number of children with special needs who have been adopted with federal
adoption assistance has increased by over 60 percent since 1993.
President Clinton's Initiative to Increase Adoption. On December 14, 1996, President Clinton
announced a comprehensive initiative to reduce barriers to adoption and double the number of
children adopted or permanently placed each year, from 27,000 in 1996 to 54,000 in 2002. The
initiative, Adoption 2002, recognizes that foster care is a temporary solution and not an appropriate
place for children to grow up. As part of the President's initiative, HHS on October 17, 1997
awarded 40 demonstration grants totaling $7.9 million for programs aimed at increasing adoptions
and reducing the number of children in public foster care. In November 1997, President Clinton
signed into law the Adoption and Safe Families Act of 1997, enacting a key part of the President's
plan by changing federal law to require that children in foster care receive permanent placements
within 12 months. To help states meet ambitious new adoption targets, HHS' FY 1998 budget
includes a new adoption bonus for states and $10 million for technical assistance, grants, innovative
demonstrations, and a national public awareness campaign.
Reducing Barriers to Adoption. In October 1994, President Clinton signed the Multiethnic
Placement Act, which helps increase the number of adoptions by prohibiting discrimination based on
race or ethnicity, and by increasing recruitment of parents. In August 1996, President Clinton signed
legislation providing a $5000 tax credit to families adopting children and a $6000 tax credit for
families adopting children with special needs. This tax credit is designed to help alleviate some of the
financial barriers to adoption. The President has also signed legislation enabling parents to take time
off to adopt a child without losing their jobs or health insurance. In addition, HHS is working with
state courts to improve the timeliness and quality of decision-making that leads to adoption. More
timely decisions will ensure children do not languish in foster care and can more quickly be placed in
permanent, stable families.
State Child Welfare Demonstrations. The Clinton Administration has granted ten states waivers
of federal regulations to allow them to reform their child welfare systems: California, Delaware,
Illinois, Indiana, Maryland. Michigan, New York, North Carolina, Ohio and Oregon. The states have
the flexibility to design their child protection and child welfare systems in ways that will better ensure
the safety of children in troubled families, offer preventive services that will intervene early to better
address the needs of families at risk, and improve the management of child welfare systems by
improving the efficiency and effectiveness of services.
Protecting Children. The Clinton Administration has also responded to increases in child abuse and
neglect by creating "Promoting Safe and Stable Families" programs to intervene early in troubled
families and help provide children a safe home, free of child abuse and neglect. The Administration
also secured the first funding for the Community-Based Family Resource Program. This program
provides support to statewide prevention networks and family resource programs to help identify
families at risk and intervene with appropriate services to ensure the safety of children. In addition,
HHS' Children's Bureau has created "Promoting Prevention," a bulletin that offers step-by-step
advice on how to build support for prevention activities. HHS has also established a web site
providing information on child maltreatment and effective prevention programs, as well as other
resources available to the public. The address is http://www.acf.dhhs.gov/news/
FOCUSING ON CHILDREN'S UNIQUE HEALTH NEEDS
Because children's bodies respond differently than adults' to medical treatments and
environmental hazards, HHS has made meeting children's special health needs an important
part of our strategy to see that all children get a safe and healthy start in life.
Increasing Pediatric Labeling. On August 13, 1997, President Clinton unveiled a new FDA
regulation to protect children by requiring drug manufacturers to study the safety and appropriate
dosage levels of medications for pediatric populations. The regulation also requires proper labeling of
drugs for use by children. Even though many drugs affect children differently than adults, most drugs
have not been tested on pediatric populations. Under this rule, manufacturers of prescription drugs
likely to be used by children will be required to complete studies and place information on drug labels
to health care providers make scientifically-based treatment decisions when prescribing drugs to
children.
Food Safety. The Centers for Disease Control and Prevention (CDC) estimates that each year as
many as 33 million cases of foodborne illness in the United States result in up to 9,000 deaths. For
children, especially younger children, the problem is especially relevant. The president has proposed
and Congress has enacted a $43 million Interagency Food Safety Initiative for FY 1998. HHS is
partnering with the Department of Agriculture, the Environmental Protection Agency, and the
Department of Education to strengthen surveillance systems for foodborne illnesses, improve
Federal/State coordination in responding to foodborne disease outbreaks, improve oversight of our
food supply, and increase consumer awareness of safe food handling practices.
Protecting Children from Environmental Exposures. In April 1997, President Clinton issued an
executive order assigning high priority to addressing environmental health and safety risks to children.
The executive order established a Task Force on Environmental Health Risks and Safety Risks to
Children, co-chaired by the HHS Secretary and the Administrator of the Environmental Protection
Agency. The task force has identified four priority areas: 1. Asthma, 2. Unintentional injuries, 3.
Developmental disorders, 4. Cancers. Through this task force, HHS is working with the
Environmental Protection Agency (EPA) to promote policies and practices that emphasize child
health. On September 3, 1997, HHS and EPA announced that they are creating the first federal
research centers dedicated to the protection of the health of children from environmental threats. A
total of $ 10 million has been allocated for the initial year of the centers. The agencies plan to
establish six centers nationally.
INCREASING RESOURCES FOR CHIDREN'S MENTAL HEALTH SERVICES
Facilitating Community-Based Programs. Since 1992, the Comprehensive Community Mental
Health Services for Children and their Families program has worked with communities to develop
systems of care for children who need mental health services. In FY 1998, approximately $73 million
will be distributed to 40 grantees. These grants assist communities in developing local systems of care
that link mental health with child welfare, education, juvenile justice, and other appropriate agencies.
More than 24,000 children have been served in this program.
Starting Early, Starting Smart. Research shows that increasingly many young children
demonstrate problems with respect to relationships, emotions, and behavior, entering school with few
intellectual, social, and emotional school readiness skills. Our "Starting Early, Starting Smart" initiative
seeks to fill this gap by reaching children at their most critical time for mental and physical
development. This public-private collaboration is developing strategies to address the needs of
children from birth to seven years who are affected by alcohol, drug abuse, and mental health
disorders in their families. Thirteen cooperative agreements and one cross-site data center were
funded in September 1997.
HIV/AIDS Mental Health Services. As a part of Title IV of the Ryan White CARE Act, the
HIV/AIDS Mental Health Services Demonstration Program assists parents with HIV in planning for
the care of their children upon their death. The program is also aggressively promoting risk reduction
techniques and HIV education to the children of parents who have HIV/AIDS, since many of them
are at higher risk of contracting the virus.
ADOLESCENT DEVELOPMENT: "SAFE PASSAGES"
PREVENTING YOUTH TOBACCO USE
Each day, almost 3,000 young people in the United States become regular smokers, and
nearly 1,000 of them will die prematurely from diseases related to tobacco use. Each year,
more than 400,000 Americans die from smoking-related diseases, more Americans than are
killed each year by AIDS, alcohol, car accidents, murders, suicides, illegal drugs, and fires
combined.
FDA Authority. On August 23, 1996 President Clinton announced the FDA tobacco rule designed
to reduce the incidence of youth smoking. The FDA rule made it a federal violation to sell cigarettes
or spit tobacco to anyone younger than age 18, and required retailers to ask for photo identification
from anyone under age 27 who attempts to purchase tobacco products.
Tobacco Legislation. The administration has also worked to pass comprehensive national tobacco
legislation to finish the job. The President's five key principles for comprehensive tobacco legislation
are: (1) a comprehensive plan to reduce youth smoking by raising the price of a pack of cigarettes by
up to $1.50 over 10 years through a combination of annual payments and tough penalties on the
tobacco industry; (2) full authority for the FDA to regulate tobacco products; (3) changes in the way
the tobacco industry does business, including an end to marketing and promotion to children; (4)
progress toward other public health goals, including biomedical and cancer research, a reduction of
second hand smoke, promotion of smoking cessation programs, and other urgent priorities; and (5)
protection for tobacco farmers and their communities. Though the legislation was never voted on in
Congress, it is expected to be a priority item for the Administration during the next congress.
Helping Retailers Prevent Sales to Youths. On February 27, 1998, Vice President Gore
announced a new national education campaign to educate consumers and help retailers prevent illegal
sales of tobacco products to children. The Vice President also announced progress by the Substance
Abuse and Mental Health Services Administration (SAMHSA) in implementing the Synar
Amendment, legislation that requires states to monitor retailer compliance to ensure they prohibit
tobacco sales to children.
PREVENTING TEEN PREGNANCY
On January 4, 1997, President Clinton announced a comprehensive effort by his
Administration to prevent teen pregnancy. The new initiative, led by the Department of Health
and Human Services, responds to a call from the President and Congress for a national
strategy to prevent out-of-wedlock teen pregnancies and to a directive, under the new welfare
law, to assure that at least 25 percent of communities in this country have teen pregnancy
prevention programs in place. Building on the variety of efforts already underway at HHS and
around the country, the national strategy works to prevent teen pregnancies and encourage
adolescents to remain abstinent. There is reason to believe that past efforts to combat
pregnancies were successful. A study by the Centers for Disease Control and Prevention of
teen pregnancies between 1992 and 1995 showed that in each of the 42 states reporting plus
the District of Columbia, teen pregnancy rates for females aged 15-19 decreased. The decline
was 12 percent between 1991 and 1996 and four percent from 1995 to 1996. All 50 states had
a sustained decline in their teen birth rates between 1991 and 1995, and 21 of these states had
declines of more than 10 percent over this period.
Supporting Promising Approaches. The Clinton Administration supports innovative teen
pregnancy prevention strategies tailored to the unique needs of communities. HHS-supported
programs in this area already reach about 30 percent, or 1,410 communities in the United States.
HHS programs are based on five principles: (1) parental and adult involvement; (2) abstinence and
personal responsibility; (3) clear strategies for the future; (4) community involvement; and (5)
sustained commitment.
Implementing New Efforts Under Welfare Reform. Under the welfare law signed by President
Clinton on August 22, 1996, unmarried minor parents are required to stay in school and live at home,
or in an adult-supervised setting, in order to receive cash assistance. This approach was proposed by
President Clinton in 1994, and incorporated into numerous state demonstration projects approved by
the Administration prior to the new welfare law. The law also supports the creation of Second
Chance Homes, which will provide teen parents with the skills they need to become good role
models and providers for their children, giving them guidance in parenting and in avoiding repeat
pregnancies. The welfare law also provides $50 million a year in new funding for state abstinence
education activities, beginning in FY 1998. Finally, the new welfare law includes the tough child
support enforcement measures President Clinton proposed in 1994, which will send a strong
message to adolescents and adults alike that they should not have children until they are ready to
provide for them.
PREVENTING YOUTH SUBSTANCE USE
The Clinton Administration has developed a comprehensive drug strategy, with a particular
focus on preventing substance abuse by young Americans. In addition to its broad research
agenda and funding for drug treatment and prevention, HHS is targeting resources toward
public education of America's young people about the dangers of drug use.
New Initiatives. HHS plays a key role in the Administration's substance abuse strategy, leading
drug abuse research, prevention, and treatment. HHS funding accounts for about 46 percent of the
federal government's demand reduction activities, and as part of the overall Administration strategy
-- HHS is increasing its resources dedicated to preventing youth substance abuse. For FY 1998,
HHS plans to spend approximately $116 million for new youth-focused initiatives, which will work to
improve substance abuse prevention programs, raise awareness among youth, counter pro-drug
messages, and provide State level estimates of drug abuse. As part of its youth strategy, HHS has
awarded State Incentive Grants for Community-Based Action to Governor's offices in 19 States to
support statewide planning for coordinated substance abuse prevention services. HHS' FY 1998
substance abuse budget totals $2.5 billion, an increase of 6 percent over the FY 1997 level.
President Clinton's FY 1999 budget continues this investment by including $2.8 billion for HHS
substance abuse-related activities, an increase of 11 percent from FY 1998. As part of his budget,
President Clinton proposed an additional $200 million in budget authority for the Substance Abuse
Performance Partnership Block Grant to increase substance abuse treatment. The President's FY
1999 budget also increases funding for youth substance abuse prevention, anti-tobacco activities, and
addiction research.
In 1997, HHS released data showing that illicit drug use among younger teens has leveled off for the
first time since 1992. The data, taken from the 1997 Monitoring the Future Survey and the 1996
National Household Survey on Drug Abuse, also shows that after doubling from 1992 to 1995,
marijuana use is leveling off among younger teens, and shows signs of beginning to level off among
older teens as well. The surveys also found an improvement in drug-related attitudes, with
disapproval of drug use increasing among younger teens.
Reality Check Anti-Marijuana Campaign. On June 24, 1996, Secretary Shalala launched Reality
Check, a national public education campaign designed to counter recent increases in marijuana use
by youth. The campaign is targeted in particular at improving information and parent-child
communications about marijuana. "Keeping Youth Drug Free: A Guide for Parents, Grandparents,
Elders, Mentors and other Caregivers," the key ingredient of the Reality Check campaign, endorsed
by the National PTA, is designed to help parents talk with their children about drug issues. The PTA
will work with HHS toward the goal of distributing the guide to some 14 million parents. A Reality
Check web site is on the National Clearinghouse for Alcohol and Drug Information (NCADI)
homepage (http://www.health.org/reality).
Guide to Preventing Youth Substance Abuse. On March 6, 1997, HHS' National Institute on
Drug Abuse released the first research-based guide to preventing young people from using drugs.
The new guide, "Preventing Drug Use Among Children and Adolescents: A Research-Based Guide,"
can be obtained free of charge from the National Clearinghouse for Alcohol and Drug Information
(NCADI) at 1-800-729-6686.
Targeting At-Risk Youths. HHS has launched new initiatives to address the unique needs facing
at-risk youths including children from low-income minority groups and children in rural areas.
HRSA's Minority Adolescent Health Program targets minority children disproportionately at-risk for
injury, violence and mental health problems. Other programs are focusing on HIV/AIDS education,
adolescent pregnancies, school health and genetic disorders. To address the needs of children in rural
areas, HRSA's Rural Health Services Outreach Grant Program provides fiends to rural people who
lack access to health care. Services provided to children include immunizations, suicide prevention
and developmental testing.
Positive Activities Campaign. This component of the Secretary's Youth Substance Abuse
Prevention Initiative seeks to raise awareness of the connection between youth participation in
positive skill-building activities with caring adults and the reduction of substance abuse by young
people. The campaign identifies ways adults can provide positive activities for children as a means of
reducing existing use of drugs among youths age 7 to 14.
PROMOTING HEALTHY DEVELOPMENT
HHS is supporting new partnership efforts to help adolescents in their development to
adulthood. HHS efforts are aimed at areas where research has shown a need for extra efforts.
Girl Power! Launched in November 1996, Girl Power! is a multi-phase, national public education
campaign sponsored by the Department of Health and Human Services to help encourage and
empower 9- to 14-year-old girls to make the most of their lives. Studies show that girls tend to lose
self confidence and self worth during this pivotal age, becoming less physically active, performing less
well in school, and neglecting their own interests and aspirations. It's during these years that girls
become more vulnerable to negative outside influences and to mixed messages about risky behaviors.
Girl Power! is designed to combine strong "no-use" messages about tobacco, alcohol, and illicit
drugs with an emphasis on providing opportunities for girls to build skills and self-confidence in
academics, arts, sports, and other endeavors. Within the first 18 months of the campaign, Girl
Power! product requests and web site hits totaled more than 5 million. Girl Power! has more than
100 public and private partners, including young, visible leaders like Olympic Gold Medallist
Dominique Dawes.
"Choose Your Cover" Skin Cancer Prevention Campaign. In May 1998 HHS Secretary
Donna E. Shalala launched a national, multi-year awareness initiative to prevent skin cancer among
Americans. The "Choose Your Cover" public service announcements target 18- to 25-year-olds, an
age group that spends many hours out in the sun. The "Choose Your Cover" initiative will also reach
out to 9- to 18-year-olds a critical time when adolescents set patterns of behavior that they carry
with them into adulthood.
Promoting Physical Activity. According to the 1996 study Physical Activity and Health: A Report
by the Surgeon General, 60 percent of young people are not regularly active. In March 1997, the
CDC reported that the proportion of young people who are overweight has more than doubled in the
last 30 years. To try to reverse these trends, the CDC on March 13, 1997 released new guidelines
urging schools, parents and communities to promote physical activity programs for young people that
will lead to lifelong benefits. In its "Guidelines for School and Community Health Programs to
Promote Lifelong Physical Activity Among Young People," CDC makes comprehensive
recommendations, aimed at encouraging physical activity for youngsters today as well as creating
lifetime physical activity habits. The guidelines recommend physical education programs for all
children in kindergarten through 12th grade, and at the same time they suggest new and different--
kid friendly -- approaches and urge parents and communities to become involved.
Other HHS Fact Sheets on Child and Adolescent Issues:
Children's Health Insurance Program (CHIP) July 17, 1998 Preventing Teen Pregnancy June 25,
1998 Child Support Enforcement: A Clinton Administration Priority June 24, 1998 The Childhood
Immunization Initiative April 20, 1998 13 - 15 -
FAX
J. KLEIN
HHS FACT SHEET
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
December 31, 1997
Contact:
HHS Press Office
(202) 690-6343
1997: HHS CONTINUES PROGRESS TOWARD KEY GOALS
In 1997, HHS made significant strides toward ensuring that Americans have the tools they
need to lead healthy and productive lives. Through targeted investments, we helped continue the
important progress we 've made since 1993 toward creating a stronger and healthier nation.
And through better management, we streamlined and strengthened our services.
In particular, we took important steps toward improving health care access and quality.
Under the Balanced Budget Act of 1997, we launched an historic expansion of health care for
our nation's children. We also strengthened the Medicare and Medicaid programs, adding
important new benefits and extending the life of the Medicare Trust Fund without raising
premiums.
President Clinton also appointed a new advisory commission to improve health care
quality, which proposed a new Consumer Bill of Rights. And we began implementation of the
landmark Health Insurance Portability and Accountability Act of 1996, which includes
important new protections for an estimated 25 million Americans who move from one job to
another, who are self-employed, or who have pre-existing medical conditions. We also initiated
a new effort to ensure privacy of personal health records, and achieved unprecedented levels of
recoveries and prosecutions under our expanded effort to fight health care fraud and abuse.
In addition, HHS again reported significant gains in key indicators of our nation's health.
AIDS deaths declined for the first time in the history of the epidemic, and teen birth rates
declined for the fifth straight year. Infant mortality rates reached a new record low, and more
women than ever before received prenatal care. Childhood immunization rates reached a record
high, meeting the goals we set in 1993, and rates of vaccine preventable childhood disease fell to
all-time lows.
HHS also announced new signs of progress in combating teen drug use with two
comprehensive studies showing the first leveling off of drug use among young leens since 1992.
And we achieved the largest decline in welfare caseloads in history.
In the coming year, we will continue to build on these accomplishments and prepare HHS
-- and the nation -- for the 21st century. As part of this effort, we will work with Congress to
craft bipartisan legislation to enact the Consumer Bill of Rights for health care, protect the
privacy of health records, and dramatically reduce youth tobacco use.
Donna E. Shalala
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BUILDING STRONG FOUNDATIONS FOR INFANTS AND YOUNG CHILDREN
New Children's Health Insurance Program. At President Clinton's urging, the Balanced Budget Act
of 1997, signed into law by the President on August 5, 1997, provides the largest increase in funds
available for health insurance for low-income children since the creation of Medicaid in 1965. The $24
billion set-aside for children, administered by HHS, will allow states to extend health coverage to millions
of uninsured children by expanding their current Medicaid programs or by creating new health insurance
plans.
Increasing Adoptions. On February 14, 1997, HHS submitted to President Clinton Adoption 2002, a
new action plan to help states set and meet urgent new adoption targets. The report, developed under a
Presidential directive signed by President Clinton in December 1996, takes its name from the President's
goal to at least double by the year 2002 the number of children adopted or permanently placed each year.
Specific recommendations contained in the report included changing federal law to clarify reasonable
efforts to reunite families, offering financial incentives to states to increase adoptions and permanent
placements, and providing technical assistance to states, courts, and communities to move children more
rapidly from foster care to permanent homes. In November 1997, President Clinton signed into law the
Adoption and Safe Families Act of 1997, enacting a key part of the President's plan by changing federal
law to require that children in foster care receive permanent placements within 12 months. As part of the
President's initiative, HHS also awarded 40 demonstration grants in October 1997 for programs aimed at
increasing adoptions and reducing the number of children in foster care. In 1997, HHS also awarded
child welfare waivers to six states to allow them to test innovative strategies to improve child welfare
systems.
Improving Child Care. On October 23, 1997, President Clinton hosted the first-ever White House
Conference on Child Care to focus the nation's attention on the importance of addressing the need for
safe, affordable, quality child care. This Conference underscores and builds upon the Clinton
Administration's commitment to strengthening the American family by giving parents the tools they need
to fulfill their responsibilities and giving children the ability to reach their full potential. At the
Conference, HHS proposed a National Child Care Provider Scholarship Fund that will increase child care
providers' incentives to complete child care-related course work.
Head Start Expansion Initiative. In March 1997, HHS announced a new Head Start initiative that will
expand Head Start services for children while also helping parents on welfare move to work. Under the
new initiative, Head Start expansion funds are being used for the first time to build partnerships with child
care providers to deliver full-day and full-year Head Start services. Full-day and full-year services, in turn,
can help parents attain full-time work. Through the Head Start-child care partnerships, Head Start and
child care agencies combine staff and funds to provide high quality services. Children stay in one place all
day, rather than attending Head Start for half a day and then moving to child care for the remainder of the
day. Since taking office, the Clinton Administration has nearly doubled funding for Head Start, increased
the number of children and families served by approximately 35 percent to about 836,000, and expanded
the number of children age 0-3 in Head Start to over 37,000.
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Record Vaccination Levels. In July 1997, HHS announced that childhood immunization rates reached a
new all-time high of 78 percent in 1996 for the complete series of recommended vaccinations. In
addition, HHS announced that the nation had exceeded its childhood vaccination goals for 1996, with 90
percent or more of America's toddlers receiving the most critical doses of the most routinely
recommended vaccines for children by age two. Also in 1996, reported levels of preventable childhood
diseases were at near or record lows, and three diseases reached the elimination targets. The 1996 goals
were set in 1993 when President Clinton launched the comprehensive Childhood Immunization Initiative
(CII), led by the CDC, in response to low vaccination rates among preschool children.
Record Progress In Preventing Infant Mortality. In 1997, HHS announced that the nation had again
reached a record low infant mortality rate. Driving the overall decline in infant mortality was a 15
percent decline in infant deaths attributed to Sudden Infant Death Syndrome (SIDS) between 1995 and
1996. This decline is largely attributed to the increase in awareness produced by the Department's Back
to Sleep campaign, which spreads the message that infant caregivers can reduce the risk of SIDS by
placing babies on their backs to sleep. In addition, HHS announced in 1997 that a record number of
women are receiving prenatal care in their first trimester of pregnancy. To help build on this progress,
HHS in February 1997 announced the nation's first toll-free referral and information service to help
women obtain proper prenatal care throughout their pregnancies. Callers in all 50 states can now call
1-800-311-BABY (2229) for pregnancy and prenatal care information, including referral to local clinics
and physicians. A separate phone number is available for Spanish speakers: 1-800-504-7081. The
service is supported by HRSA's Healthy Start program.
Increasing Availability of Pediatric Use Information for Prescription Drugs. On August 13, 1997,
President Clinton unveiled a new FDA regulation that will protect children by requiring drug
manufacturers to study the safety and appropriate dosage levels of medications for pediatric populations.
The regulation also requires proper labeling of drugs for use by children. Even though many drugs affect
children differently than adults, most drugs have not been tested on pediatric populations. Under this
rule, manufacturers of prescription drugs likely to be used by children will be required to complete studies
and place information on drug labels to help pediatricians and other health care providers make
scientifically-based treatment decisions when prescribing drugs to children.
ENSURING SAFE PASSAGES TO ADULTHOOD FOR ADOLESCENTS
National Strategy to Prevent Teen Pregnancy. HHS announced in 1997 that the birth rate for teens
aged 15-19 has declined five straight years in row, decreasing by 12 percent between 1991 and 1996. To
build on this success, the Clinton Administration in January 1997 launched a comprehensive effort to
prevent teen pregnancy and encourage adolescents to remain abstinent. The new initiative, led by HHS,
builds on the variety of efforts already underway at HHS and in communities across the country. The
initiative also responds to a call from the President and Congress for a national strategy to prevent out-of-
wedlock teen pregnancies and to a directive, under the new welfare law, to assure that at least 25 percent
of communities in this country have teen pregnancy prevention programs in place. To supplement this
effort, HRSA in 1997 began awarding $50 million a year in new funding for state abstinence education
activities, provided for under the new welfare law. And in May 1997, HHS announced the availability of
two new $1 million grant programs for communities to develop innovative approaches to prevent teen
pregnancy - one targeted to girls and the other to boys.
- 4
New Signs of Progress in Combating Youth Drug Use. In 1997, HHS released data showing that
illicit drug use among younger teens has leveled off for the first time since 1992. The data, taken from
the 1996 National Household Survey on Drug Abuse and the 1997 Monitoring the Future Survey, also
shows that after doubling from 1992 to 1995, marijuana use is leveling off among younger teens, and
shows signs of beginning to level off among older teens as well. The surveys also found signs of
improvement in drug-related attitudes, with disapproval of substance abuse increasing among younger
teens. To bolster efforts to prevent youth substance abuse, HHS in October 1997 awarded a total of $15
million in grants to Governors' offices in five states to support statewide planning for coordinated youth
substance abuse prevention services. Another $5 million was awarded to five regional centers, which will
help the states implement well grounded, research-based substance abuse prevention strategies. HHS
also released the first research-based guide to preventing young people from using drugs, and approved
the first non-prescription test system for drugs of abuse.
First Provisions of the President's Plan to Reduce Youth Tobacco Use Become Effective. On
February 27, 1997, the first provisions of the FDA's comprehensive rule to prevent the sale of tobacco
products to children went into effect. In February, the FDA launched a nationwide outreach effort to
educate retailers, parents and community leaders about the provisions of the FDA rule to protect children
from tobacco products, and on August 1, 1997, the FDA joined with 20 national retailer, consumer and
health professional organizations to launch a major poster campaign to assist retailers in enforcing age
and photo ID provisions. In September 1997, President Clinton called for comprehensive national
legislation to build on the FDA rule and significantly reduce children's use of tobacco products.
IMPROVING HEALTH CARE QUALITY
HHS Takes First Steps Toward Implementing Landmark Health Insurance Legislation. On April
1, 1997, HHS announced new regulations as the first step in implementing key provisions of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), signed into law by President Clinton on
August 21, 1996. The regulations focus on limiting exclusions for pre-existing medical conditions,
prohibiting discrimination against employees and dependents based on their health status, guaranteeing
availability of health insurance to small employers, and guaranteeing renewability of insurance to all
employers regardless of size. In addition, Secretary Shalala on September 11, 1997 submitted to
Congress recommendations for Federal health record confidentiality legislation as called for in the Act.
The recommended legislation would guarantee rights for patients and define responsibilities for record
keepers, so that there will be clear guidance and real incentives for confidential, fair, and respectful
treatment of personal health information, and penalties for its misuse. Using these recommendations as a
guide, HHS will work with Congress to enact bipartisan legislation to guarantee these protections.
Advisory Commission on Consumer Protection and Quality in the Health Care Industry. In March
1997, President Clinton announced the members of the Advisory Commission on Consumer Protection
and Quality in the Health Care Industry, created through an Executive Order signed by President Clinton
to build on his Administration's commitment to improving the quality of the nation's health care system.
The 32-member Commission will review rapid changes in the health care financing and delivery systems
and make recommendations, where appropriate, on how best
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to preserve and improve the quality of the nation's health care system. Co-chaired by the Secretaries of
Health and Human Services and Labor, the Advisory Commission has broad-based representation from
consumers, businesses, labor, health care providers, insurers, and quality and financing experts.
Consumer Bill of Rights. In November 1997, the Advisory Commission on Consumer Protection and
Quality in the Health Care Industry announced their recommendation for a "Consumer Bill of Rights" to
promote and assure patient protections and health care quality. The three goals of the Consumer Bill of
Rights are: (1) to strengthen consumer confidence that the health care system is fair and responsive to
consumer needs; (2) to reaffirm the importance of a strong relationship between patients and their health
care providers; and (3) to reaffirm the critical role consumers play in safeguarding their own health. The
President has asked all federal agencies to develop plans for applying the "Consumer Bill of Rights" to
their workforce, and challenged private health care plans to adopt the standards. The Clinton
Administration will work with Congress in the coming year to craft bipartisan legislation to enact the
Commission's recommendations. The full text of the Consumer Bill of Rights is available on the Internet
at www.hcqualitycommission.gov.
Ban on Time Limits for Breast Cancer Surgery. In February 1997, HHS announced steps to ensure
that Medicare beneficiaries are protected from any requirements by health plans that would place time
limits on hospital stays for mastectomies. In letters to 350 managed care plans contracting with
Medicare, HHS said outpatient surgery or limitation on hospital stays may not be required by plans for
beneficiaries undergoing surgery for the treatment of breast cancer. Medicare paid for more than 84,000
mastectomies last year, or about a third of all mastectomies in the U.S. This action coincides with a call
by President Clinton for bipartisan legislation to guarantee that a woman can stay in the hospital for 48
hours following a mastectomy.
New Patient Appeals Rights. Response within 72 hours to appeals of care denials is required for
Medicare beneficiaries under regulations enacted by HHS in April 1997. This regulation covers decisions
that could jeopardize life, health or ability to regain maximum function, and terminations of care, such as
skilled nursing facility discharge.
Physician Incentive Rules. As of January 1997, health plans are required to disclose financial incentives
and pay for stop-loss insurance for physicians so they can lose no more than 25 percent of their income if
the cost of care for their patients exceeds what they are paid by the plan. The regulations also ban any
incentive arrangements that include payments to doctors to limit or reduce medically necessary services.
These rules are designed to make sure incentives to discourage unnecessary services do not jeopardize
quality patient care.
Standardizing Health Plan Performance Measurement. In January 1997, HCFA formally launched
the Medicare Health Plan Employer Data Information Set (HEDIS), a partnership with the Kaiser Family
Foundation to establish a performance measurement system that will minimize reporting burdens on
managed care plans serving Medicare beneficiaries. The new measures will help plans to improve the
quality of their care and support efforts to improve the health status of beneficiaries.
6
Medicare Managed Care Marketing Guidelines Released. On September 8, 1997, HHS issued
marketing guidelines to help Medicare beneficiaries make informed choices about managed care plans.
The guidelines will inform health plans serving Medicare what is, and is not, allowed under Medicare
managed care regulations on advertising, enrollment, and required notifications to Medicare beneficiaries.
The guidelines will also help expedite review of marketing materials by the Health Care Financing
Administration, which runs the Medicare program.
FIGHTING HEALTH CARE FRAUD, WASTE, AND ABUSE
Record Recoveries and Prosecutions. On September 29, 1997, HHS announced that the Department's
expanded efforts to fight fraud and abuse in health care are paying off, with unprecedented levels of
recoveries and prosecutions. In FY 1997, HHS identified $1.2 billion for collection in total fines,
restitutions, settlements, and recoveries -- the most ever identified in one year. The FY 1997 total was
six times higher than recoveries for FY 1996, and over three times higher than the previous best year for
recoveries. In addition, criminal and civil prosecutions totaled 1,340 cases in FY 1997 -- double the
number for FY 1996, and more than five times the total number in FY 1995. Over 2,700 health care
providers and entities were excluded from doing business with Medicare, Medicaid, and other federal and
state health care programs for engaging in fraud or abuse of the programs -- an 86 percent increase from
the 1,400 exclusions in FY 1996. Since 1993, actions affecting HHS programs alone have saved
taxpayers more than $20 billion and increased health care fraud convictions by 240 percent.
Expanding Operation Restore Trust. In May 1997, Secretary Shalala announced a new, nationwide
expansion of Operation Restore Trust (ORT), the Department's comprehensive anti-fraud initiative. ORT
was started in 1995 as a two-year, five state pilot program to test the success of several innovations in
fighting fraud and abuse in the Medicare and Medicaid programs. During the demonstration, ORT
identified $23 in overpayments for every $1 spent looking at the fast-growing areas of Medicare,
including home health care, skilled nursing facilities, and providers of durable medical equipment.
Tightening Standards for Health Care Providers Participating in Medicare and Medicaid. On
September 15, 1997, President Clinton announced three new weapons to fight fraud and abuse in the
home health care industry, the fastest growing part of the Medicare program. The President announced:
(1) an immediate moratorium on all new home health providers coming into the Medicare program while
HHS implements new regulations to prevent risky providers from entering the program; (2) a new
renewal process for home health agencies currently in the program to help weed out fraudulent providers;
and (3) a doubling of audits to help increase detection of fraud and abuse. In addition, the Clinton
Administration in March 1997 proposed a new regulation that would revise the federal standards, called
Conditions of Participation, that health care providers must meet in order to participate in the Medicare
program. The new rule, included at the President's urging in the Balanced Budget Act of 1997, requires
applicants to provide their social security numbers and employer identification numbers so HCFA can
check for past fraudulent activity, and to conduct criminal background investigations on the staff they
hire. The Balanced Budget Act will further reduce fraud and abuse in home health care by establishing a
prospective payment system for home health services, tightening eligibility, and developing guidelines for
use of home health services.
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New Resources for Fraud and Abuse Control. In FY 1997, the HHS Office of the Inspector General
(OIG) received $70 million from the new Health Care Fraud and Abuse Control Account created under
the Health Insurance Portability and Accountability Act of 1996. The landmark Act, signed into law by
President Clinton in August 1996, created a stable source of funding for health care fraud control efforts
for the first time. The new funding has enabled the OIG to open six new field offices to facilitate
enforcement actions, increasing from 26 to 31 the number of states in which the OIG is present. In
addition, HHS in August 1997 awarded more than $2.25 million in grants funded by HIPAA through
HCFA and the Administration on Aging for new programs to aid in the fight against health care fraud and
abuse. Provisions under HIPAA will also establish a fraud and abuse database to identify health care
providers who have been the subject of adverse actions as a result of illegal or abusive practices, and
award grants to partner agencies engaged in investigations, prosecutions, and audits of health care fraud
and abuse.
Medicare Fraud Hotline Improved and Expanded. In July 1997, HHS expanded the Medicare fraud
hotline started in 1995 to report fraud and abuse in Medicare and Medicaid programs. Over 32,000
complaints that warranted follow-up action have been received since it began service. The hotline is
staffed Monday through Friday, 8 a.m. to 5:30 p.m. Eastern Standard Time, and assistance is available in
both English and Spanish. The toll-free Hotline number is 1-800-HHS-TIPS (1-800-447-8477). The
TTY number for the hearing impaired is 1-800-377-4950 and the fax number is 1-800-223-8164.
Medicare Secondary Payer Initiatives Produce Significant Savings. In 1997, HCFA saved more than
$1.1 billion because of new initiatives that help Medicare avoid paying bills that should be paid by other
insurers. The Initial Enrollment Questionnaire and Prospective Data Sharing initiatives are both
identifying Medicare beneficiaries who have other health insurance coverage. Under Medicare Secondary
Payer (MSP) laws, other insurers covering Medicare beneficiaries often must pay claims before Medicare.
This applies, for example, to beneficiaries with coverage through current employment.
PROGRESS IN THE FIGHT AGAINST HIV/AIDS
First Ever Decline in AIDS Deaths. In September 1997, HHS reported that, for the first time in the
history of the epidemic, the number of Americans diagnosed with AIDS declined, falling six percent for
Americans over age 12 between 1995 and 1996. In addition, HHS reported that HIV/AIDS mortality
declined 26 percent between 1995 and 1996, falling from the leading cause of death among 25-44 year
olds to the second leading cause of death in that age group. The CDC also reported a slowing in the
epidemic overall and a 43 percent decline in perinatally acquired AIDS cases between 1995 and 1996.
AIDS Vaccine Initiative. On May 18, 1997, President Clinton challenged the nation to commit itself to
the goal of developing an AIDS vaccine within the next ten years. The President also announced a
number of important initiatives to help fulfill this commitment, including high-level international
collaboration, a dedicated research center for AIDS vaccine research at NIH, and outreach to scientists,
pharmaceutical companies, and patient advocates to maximize the involvement of both private and public
sectors in the development of an AIDS vaccine. As part of this effort, the National Institute of
Allergy and Infectious Diseases at NIH in September 1997 announced the first grant recipients in its new
program to foster innovative research on AIDS vaccines.
- 8
New Treatment Guidelines. In 1997, HHS released draft guidelines for treating HIV with antiretroviral
drugs. The guidelines, developed by panels of AIDS clinicians and researchers, reflect the current state
of knowledge about HIV disease and antiretroviral drugs, and will help standardize and improve the
quality of care for HIV-infected persons in the United States.
Increased Access to AIDS Drugs. In 1997, HHS dramatically increased funding for the AIDS Drug
Assistance Program, significantly increasing access to promising treatments for HIV and AIDS. ADAP
funding increased by 70 percent, and nearly 80,000 people benefited from the program in 1997. In
addition, the FDA approved four new AIDS drugs and two drugs for AIDS related conditions in 1997.
In March 1997, the FDA approved the first protease inhibitor with labeling for use in children.
IMPROVING DEPARTMENT MANAGEMENT
Increasing On-Line Access to Health Information. In April 1997, HHS launched Healthfinder, a new
government gateway site on the Internet that brings together under one umbrella the broad range of
consumer health information resources produced by the federal government and its many partners. Its
current resources include hyperlinks to more than 1,000 Web sites and nearly 1,200 selected online
documents. The address for Healthfinder is http://www.healthfinder.gov To provide better access to
research information, the National Library of Medicine at the NIH in June 1997 launched a new service to
provide all Americans free access to MEDLINE -- the world's most extensive collection of published
medical information - over the World Wide Web. Prior to this announcement, users have had to register
and pay to search MEDLINE and other NLM databases. MEDLINE can be accessed at:
http://www.nlm.nih.gov. Also in June 1997, HHS announced a new "Computers for Seniors" program
designed to help give older Americans access to the Internet and help them make better use of Medicare,
Medicaid and other HHS programs.
Streamlining and Modernizing the FDA. In 1997, the FDA made significant progress in streamlining
operations to improve consumer access to drug information, cut red tape, and speed approval of new
medical products and devices. To date, the agency has cut new drug approval times nearly in half, while
the number of new drugs approved in a year has doubled. In recognition of its innovations of the U.S.
drug approval process, the FDA was named a 1997 winner of the prestigious Innovations in American
Government Awards Program, sponsored by the Ford Foundation and Harvard University's John F.
Kennedy School of Government. To build on this progress, President Clinton signed into law the FDA
Modernization Act of 1997 on November 21, 1997, improving the regulation of food, medical products
and cosmetics. In 1997, the FDA also proposed a "new use initiative" to speed up the development of
new and supplemental uses of medications; announced new, easier to understand labels for over-the-
counter drugs; and launched an initiative to provide consumers with better, easier to understand
information about prescription drugs. In addition, the FDA announced a plam to reinvent the regulation
of human tissue, the FDA's sixth reinvention effort as part of the Clinton Administration's Reinventing
Government Initiative.
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MOVING FORWARD ON THE PROMISE OF WELFARE REFORM
Largest Caseload Decline in History. In 1997, HHS announced that the welfare caseload fell by 3.4
million recipients, from 14.1 million in January 1993 to 10.7 million in May 1997, a drop of 24 percent
since the Clinton Administration took office. Forty-eight out of fifty states have seen their caseloads
decline, with ten states reducing their rolls by 40 percent or more in the last four years. This is the largest
welfare caseload decline in history and represents the lowest percentage of the population on welfare
since 1970. According to an analysis released in 1997 by the Council of Economic Advisors (CEA), the
reduction in the welfare rolls can be attributed to the strong economic growth during the Clinton
Administration, the waivers granted to states to test innovative strategies to move people from welfare to
work, and other factors, such as the Administration's expansion of the Earned Income Tax Credit.
Overhauling the Welfare System Nationwide. On July 1, 1997, the historic welfare law that the
President signed last August went in to effect in every state, making work and responsibility the law of
the land. HHS has certified welfare plans for each state. In accordance with the welfare law, all plans
require and reward work, impose time limits, and demand personal responsibility. The balanced budget
that the President signed on August 5, 1997 delivered on the President's pledge to fulfill the promise of
welfare reform by investing in moving people from welfare to work and fixing the provisions in the law
that had nothing to do with welfare reform, including restoring disability and health benefits to legal
immigrants who are currently receiving benefits or become disabled in the future, and continuing
Medicaid coverage for currently disabled children receiving SSI. On November 17, 1997, HHS proposed
regulations under the new law which are intended to help all welfare recipients who can work go to work,
and to encourage states to work with all families.
Record Child Support Enforcement. Due to the President's unprecedented and sustained campaign to
make noncustodial parents pay the child support they owe, HHS announced in 1997 that it had collected
a record $12 billion in child support in 1996, an increase of 50 percent since 1992. In addition, HHS
announced that paternity establishment almost doubled to nearly 1 million cases in FY 1996, from
516,000 in 1992. And the number of families actually receiving child support rose to 4 million cases with
collections, an increase of 43 percent over 1992. To build on this progress, the new welfare law includes
tough child support measures long-supported by the President, including: a national new hire reporting
system; streamlined paternity establishment; uniform interstate child support laws; computerized state-
wide collections; and tough new penalties. These measures are projected to increase child support
collections to more than $24 billion in the next ten years.
New Proposal to Improve State Child Support State Incentive Payments. On March 13, 1997,
Secretary Shalala submitted to Congress a proposal designed to further improve the performance of state
child support enforcement programs by linking federal incentive payments to states to their performance
in five key areas: establishment of paternity, establishment of child support orders, collections on current
child support owed, collections on previously or past due child support owed, and cost-effectiveness.
The five areas are intended to better measure the performance of states in fostering parental support for
children and family self-sufficiency. Current law provides for HHS to make incentive payments to states
for their child support enforcement systems, but these payments are based only on cost-effectiveness.
Under the new welfare reform law, HHS was authorized to prepare an
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alternative plan. On September 16, 1997, Secretary Shalala joined Reps. Clay Shaw and Sandy Levin in
announcing bipartisan legislation drawn from the HHS proposal. The legislation would provide incentive
funds to states which deliver real results for children who need child support payments from non-
custodial parents. To reinforce the goal of achieving self-sufficiency, states will be rewarded for
collection in all child support cases, but with a stronger emphasis on welfare and former welfare cases.
The House passed this legislation in 1997, and action on the bill is pending in the Senate.
OTHER SIGNIFICANT ACCOMPLISHMENTS
Ensuring Food Safety. In 1997, HHS dramatically increased attention on food safety. In January,
President Clinton announced a comprehensive new food safety initiative to help detect and respond to
outbreaks of foodborne illness earlier, and to give us the data we need to prevent future outbreaks. The
CDC and the FDA play a key role in this new initiative. Key components of the new initiative include:
building a national Early Warning System to identify infectious agents and their sources and rapidly
communicate these findings nationwide; developing new methods for monitoring the food supply;
strengthening intergovernmental coordination to reduce and improve responses to outbreaks of
foodborne illnesses; and improving awareness of food safety practices. Building on the President's
initiative, the FDA in August 1997 announced new measures to reduce the risk of illness from disease-
causing microbes in unpasteurized fruit and vegetable juices, and in October announced an initiative to
upgrade domestic food safety standards and to ensure that fruits and vegetables coming from overseas
are as safe as those produced in the United States. In addition, the FDA in December 1997 approved the
irradiation of meat products to control disease-causing micro-organisms.
Improving Guidance on Mammography. In March 1997, NIH issued a recommendation that women
age 40 and over be screened with mammography every one to two years. In addition, NIH recommended
that women at higher risk of breast cancer get expert medical advice even before the age of 40 about
when to begin screening and about the frequency of their screening. To support this new
recommendation, President Clinton proposed and Congress adopted an expansion of Medicare coverage
which will help pay for annual mammograms for all Medicare beneficiaries age 40 and over. The new
benefit will be available starting January 1, 1998. In addition, the FDA in October 1997 announced final
regulations that significantly improve the quality and performance of equipment and personnel at all U.S
mammography facilities. The regulations implement the Mammography Quality Standards Act (MQSA)
passed by Congress in 1992. The MQSA requires that all mammography facilities meet stringent quality
standards, be accredited by an FDA-approved accreditation body, and be inspected annually.
First Biotechnology Product to Treat Cancer. On November 26, FDA approved Rituxan, the first
biotechnology product to treat cancer. The drug is used to treat a type of non-Hodgkin's lymphoma.
Rituxan targets and destroys white blood cells involved in the disease. Because specific cells are
targeted, rather than all fast-growing cells, as is the case for most chemotherapy, tumor shrinkage is
accomplished with fewer toxic side effects than other cancer treatments.
- 11 -
Increasing Organ Donation. In December 1997, HHS launched a National Organ and Tissue Donation
Initiative aimed at increasing the number of organ donations and reducing the number of Americans who
die each year while waiting for organ transplantation. The initiative builds on more than a decade of
experience gained from government, private, and volunteer efforts. Focusing on known barriers to
donation, it will: (1) create a broad partnership of public, private, and volunteer organizations to
encourage Americans to agree to organ and tissue donation; (2) emphasize the need to share personal
decisions on organ donation with one's family; (3) work with health care providers, consumers, and
physicians to ensure that deaths are reported to organ procurement organizations whenever there is
potential for donation; and (4) learn more about what works to bring about donation, through research
and evaluation, including an HHS conference on best practices next spring.
###
PRESIDENT BILL CLINTON:
MEETING AMERICA'S CHALLENGE OF CHERISHING OUR
CHILDREN AND STRENGTHENING AMERICA'S FAMILIES
"Our first challenge is to cherish our children and strengthen America's families.
Family is the foundation of American life. If we have stronger families, we will
have a stronger America."
President Clinton, State of the Union Address
January 23, 1996
May 1996
A RECORD OF ACCOMPLISHMENT:
Cherishing Our Children
Announced a breakthrough agreement with the media and entertainment industry to develop a
television ratings system to enable parents to protect their children from violence and adult content.
Gave parents greater control over what their children watch on television by requiring the installation of
anti-violence screening chips ("V-chips") in all new televisions.
Proposed targeted measures to cut off children's access to tobacco products and to ban advertising
directed at children.
Established a Childhood Immunization Initiative to ensure vaccinations and healthy futures for all chil-
dren. The President's initiative contributed to the immunization of 75% of two-year children in 1995, an
historic high.
Strengthening Our Families
Enabled workers to take up to 12 weeks of unpaid leave to care for a family member without fear of
losing their jobs. (Family and Medical Leave Act)
Provided tax relief for 15 million working families by increasing the Earned Income Tax Credit to
allow more families to qualify for tax rebates.
Helped families move from welfare to work by authorizing 37 states to bypass existing welfare rules and
set time limits on benefits, require recipients to work or stay in school, provide child care and give
employers incentives to hire welfare recipients. These waivers are making work and responsibility a way of
life for 75% of all welfare recipients.
Breaking the cycle of welfare dependency by requiring teenage mothers to live at home, stay in school
and turn their lives around.
Ensuring Responsibility
Collected a record $11 billion in child support in 1995 through tougher enforcement, almost a 40%
increase over 1992.
Issued an Executive Order to help track down federal workers who fail to pay child support.
Worked with community, business and religious leaders to form a national campaign to reduce teen
pregnancy.
Making Our Communities and Schools Safer
Won passage of the toughest, smartest Crime Bill ever which puts 100,000 more police officers on
the street; imposed a targeted "Three-Strikes-and-You're-Out" provision to put career violent offenders
behind bars for life; expanded the death penalty to include drug kingpins, murderers of federal law
enforcement officers and nearly 60 additional categories of violent felons; and provided funding for
100,000 more prison cells to help states ensure that violent offenders serve their full sentences.
Stood up to the gun lobby and won passage of the Brady Bill - as a result, more than 60,000
fugitives, felons and other criminals have already been blocked from buying handguns.
Banned the manufacture and importation of 19 of the deadliest assault weapons while specifically
protecting more than 650 legitimate sporting weapons. (Assault Weapons Ban)
Tripled funding for battered women's shelters and provided $26 million in state grants to bolster
local law enforcement, prosecution and victims' services to better address violence against women.
(Violence Against Women Act)
Established nationwide 24-hour domestic violence hotline providing immediate crisis intervention,
counseling and referrals for those in need.
Keeping dangerous weapons out of our children's classrooms by enforcing a "Zero Tolerance" gun
policy in schools.
Reducing violence and drug abuse in our schools by investing in school security, drug prevention
programs and counseling. (Safe and Drug-Free Schools Act)
Encouraged schools to adopt school uniform policies to help reduce violence while promoting
discipline and respect.
Making the Necessary Investments in Education
Increased Head Start funding by almost $800 million to provide early education to tens of thousands
of additional children in need.
Supported the development of the nation's first system of voluntary standards of excellence for
students while encouraging grassroots reforms to improve our schools. (Goals 2000: Educate America Act)
Encouraged schools, colleges and employers to join in creating school-to-work opportunities, providing
students with work-based learning and giving them new pathways from high school to good jobs and
post-secondary education. (School-to-Work Opportunities Act)
Gave schools greater flexibility to use federal aid and develop effective teaching innovations to help
economically disadvantaged students achieve their full potential. (Improving America's Schools Act)
Preparing Our Schools for the 21st Century
Proposed a $2 billion Technology Literacy Challenge Fund to help communities and the private
sector ensure that every student is equipped with the computer literacy skills needed for the 21st century.
Launched an Educational Technology Initiative to connect every classroom to the Information
Superhighway and provide all students with access to computers by the dawn of the next century.
Challenged the technology industry to connect 20% of California's public schools to the Information
Superhighway by the end of this school year. This challenge became a reality in March during Net
Day '96.
Opening the Door to College
Reformed the student loan program, making college more affordable this year for 5.5 million students
and saving taxpayers billions of dollars by cutting red tape and providing loans with flexible repayment
options, including pay-as-you-earn plans. (Student Loan Reform Act)
Enabled 45,000 volunteers to earn money for college by serving their communities and their country
in the AmeriCorps program. (National Service Act)
THE CHALLENGES AHEAD:
America is moving in the right direction. The crime rate is down, welfare rolls and food stamp participation are falling
and the teen pregnancy rate has dropped. But, we still have more work to do to ensure the health, safety and futures
of our families. That is why President Clinton has issued the following challenges:
Congress should pass a bipartisan welfare reform bill that reinforces basic American values -
work, responsibility and family.
Congress should pass meaningful health insurance reform that allows people to keep
coverage when they change jobs and prevents insurance companies from denying coverage due to
pre-existing conditions.
Families must end domestic violence and work harder at staying together.
Media and entertainment industries must create movies, CD's and television shows more
suitable for children.
The Clinton Administration
Building Success for Children and Families
in the Workplace, Home, School and Community
Two years and a half years ago, I entered office with a vision for keeping the American
dream alive for children and families as we prepare for the challenges of the next century.
The end of the Cold War, the emergence of a global economy, and the coming of the
information age have all provided new opportunities and challenges for Americans, especially
for children and families.
Supporting children and families is one of the most important investments that we can make
in our future. The children and families of today will carry on the American dream for the
families of tomorrow. To create a positive future, we must build on people's strengths,
hopes, and successes. Together we must act to ensure the healthy growth and development of
our children, and the safety, stability, and economic security of our families and communities.
Workplace, School, Home and Community -- Americans look to these places to find a secure
future for their families. As parents, we ask ourselves -- does my work allow me to be the
kind of parent I want to be? Is my child learning at school? Are my children safe at home?
Does my community have the resources it needs to support my family? As the
Administration, we must find ways to answer these questions.
I firmly believe in supporting families to raise healthy, happy children so that they become
productive and active citizens. This Administration has made an unprecedented commitment
to the building blocks for success. Our efforts and our achievements touch children and
families at home where the foundations of our future are laid; in the communities where we
live; at school where we learn throughout our lives; and in the workplace, where we build the
nation's productivity and secure the resources to raise our families.
The Clinton Administration takes seriously our responsibility as a nation and as individuals to
assure the well-being of all our children and families. Although we have made great strides
in the workplace, at school, at home, and in the community, we know our job is not yet
done. We will continue to work for families as we redouble our efforts to balance the budget,
help families care for their elderly parents, reform health care, and preserve the environment.
In the pages that follow you will see what we have accomplished thus far.
BILL CLINTON
WORKPLACE
The workplace of the '90's looks very different from the workplace a generation ago. The
nature of the work is changing, the profile of the American worker is changing, and the
relationship between work and family is changing.
The Clinton Administration's commitment to the workplace is evident not only in its efforts to
create jobs, but also in its leadership to make the workplace more family-friendly, to give
young people opportunities to work productively, and to make sure that work pays more than
welfare.
Balancing Work and Family
Striking a balance between the responsibilities of work and the responsibilities of family life
is one of today's biggest challenges. With the dramatic increase in women's labor force
participation, the care-giving work traditionally done by women is now either shared by both
parents or done by provides outside the immediate family. There is an increasingly urgent
need for more child care options, flexible work schedules and job protected leave policies.
The Clinton Administration is working to make sure that parents get the support they need in
the workplace.
Improving and Expanding Child Care
The Clinton Administration has launched initiatives to make child care more
affordable and accessible by including in every budget increases for child care for parents
making the transition from welfare to work, and for those who work at very low wages and
are at risk of going on welfare, establishing a Child Care Bureau to streamline operations of
the four main Federal child care programs, improving efficiency, and launching a National
Child Care Information Center.
Passed the Family and Medical Leave Act of 1993 (FMLA)
The Clinton Administration spearheaded passage of the bi-partisan Family and
Medical Leave Act which affects an estimated 45 million U.S. workers and 300,000 U.S.
businesses. It requires public and private-sector employers of 50 or more employees to
provide up to 12 weeks of unpaid, job-protected leave in a 12-month period for the birth or
adoption of a child, to care for a child, spouse or parent with a serious health condition, or
because an employee's own serious health condition prevents him or her from working.
In one of the first lawsuits filed by the Department of Labor under FMLA, a truck driver at a San Antonio,
Texas, milk producer, alleged that the company fired him for taking emergency leave to care for his wife and
new-born triplets. The company refused to grant the employee unpaid FMLA leave to care for his family, even
though he was eligible. In the out-of-court settlement, the company agreed to pay the employee $10,000,
including approximately $6,500 in back wages.
Addressing the Concerns of Working Women and Their Families
In 1994, the Clinton Administration launched an unprecedented survey of working
women across the country to learn how they feel about their jobs. Over 1/4 million women
responded and told the government that they need improved pay and benefits, support in
balancing work and family and greater value given to women's work through increased
training and career advancement opportunities. the Administration adopted a set of
recommendations in the spring of 1995 including establishing the Working Women Count
Honor Roll to stimulate voluntary action to help working women and their families.
Making Work Pay
Expanded and Improved the Earned Income Tax Credit
President Clinton has expanded the Earned Income Tax Credit as a first step to
ensure that no child of full-time working parents has to live below the poverty line. The
expansion gives a tax cut to 15 million working families who earn up to $28,500 per year;
offers a credit to very low-income workers without children for the first time; and will more
than double the maximum credit for many families with 2 or more children.
Created 7 Million New Jobs
Helping Families Get Off Welfare
The Clinton Administration firmly believes that the welfare system must be reformed so that
parents are able to support their children through work and without government support
whenever possible. From 1954 through 1993, the number of people receiving Aid Families
with Dependant Children (AFDC) , or "welfare," increased from 11.1 million to 14.2 million.
Two-thirds of current AFDC recipients are children.
Rooted in the American values of work and responsibility, the Administration's approach to
welfare reform is to move parents off welfare and into jobs as quickly as possible by making
sure they have the training and child care they need; to require non-custodial parents to meet
their responsibilities and pay child support; and to reduce teen pregnancy.
Set out a tough welfare reform proposal
On June 14, 1994, the President introduced The Work and Responsibility Act of 1994
to "end welfare as we know it." Under President Clinton's welfare reform plan, an enhanced
work preparation and training program, (called "JOBS") is the core of the initiative to move
people from welfare to work.
Juliette, a 31-year old single mother of three children, was on
and off of AFDC over several years in Alabama She volunteered
for the JOBS Program SO she could receive day care and enter
college. Juliette earned a high grade point average while
completing an associate degree from Bishop State Community
College and a bachelor's degree from the University of South
Alabama. After graduation, she was hired as a special education
"This program is going to change my life. If it wasn't for the
help I'm getting, I'd be sitting at home."
Florida recipient on Florida's waiver approved Family
Transition Program
"After you've been in the system as long as I have and had to
scrape from month to month to make ends meet, you're ready for
something like this."
Donna Ware, Colorado welfare recipient on and off of public
Giving States More Flexibility
In two years, this Administration has approved 36 welfare reform demonstrations in 32
states -- more states than the previous two administrations combined. President Clinton has
also approved a series of executive actions to speed state experimentation and move recipients
from welfare to work.
Creating Job Opportunities for Youth
All young people should have the opportunity to gain skills and meaningful work experience.
Working helps youth acquire the discipline, competence, and self confidence to stay in school
and to become successful and responsible adults. The Clinton Administration champions
efforts to enhance job opportunities for youth
Revitalized Successful Existing Programs for Young People
The Clinton Administration has revitalized the Summer Youth Employment and
Training Program by highlighting the importance of private sector involvement and by
stressing work discipline skills. The Administration has increased funding for the very
successful residential Job Corps program and supported the construction of 8 new Job Corps
centers.
Created Innovative New Programs For Youth
The Clinton Administration created the Youth Development Initiative, which offers
grants of up to $1 million to public housing authorities for programs designed and targeted to
young public housing residents between the ages of 13 and 25, that will provide opportunities
in education, employment, as well as supportive services. In addition, the Clinton
Administration launched the Youth Apprenticeship Demonstration Program which gives at-
risk youth job training, self-sufficiency instruction, and a job through union apprenticeship.
Expanded Youthbuild
Finally, the Clinton Administration implemented and expanded Youthbuild, a
national program which provides disadvantaged young adults with education, employment
skills and work experience as they rehabilitate and build housing for low-income and
homeless individuals and families.
Expanded National Service Opportunities
With a $1.5 million Youth Apprenticeship grant, the Philadelphia Housing Authority and a
consortium of groups including the Laborer's International Union of North America, Laborer's
Local 332, and Philadelphia Youthbuild, have joined to train and employ young public,
housing residents. The Laborer's Union will provide the training, and the contractors who are
rehabilitating public housing sites will provide apprenticeship and employment opportunities.
The program will also provide the 90 participants with mentoring and social services, as they
help rehabilitate 1,000 units of public housing.
President Clinton created Americorps, which has given almost 50,000 young people a
hand in paying for their education when they serve their communities teaching, caring for the
sick, or making streets safer. He also supports the Serve and Learn program, giving
students in grades K-12 the chance to serve their communities in school-based programs.
Supporting The Development of Broad Career Opportunities For Young People
The Clinton Administration proposed the Career Preparation Education Reform Act
of 1995 which will help States, secondary and post-secondary schools develop, implement and
improve school-to-work opportunities so that all students have an opportunity to acquire the
knowledge and skills needed to meet challenging State academic standards and industry-based
skill standards.
SCHOOL
The Clinton Administration is pursuing an aggressive education agenda --with a bipartisan
coalition of lawmakers and the grassroots support of teachers, parents, community leaders
and businesses. The Clinton education agenda focuses on the importance of lifelong-learning,
and is working to link the efforts of organizations and individuals to promote the mutual
responsibilities of schools, families, and the wider community in developing successful
students.
Making Learning A Life-Long Activity
Lifelong learning starts with a firm commitment to care and education that prepares children
for school and for life. The Clinton Administration's elementary and secondary education
programs stress family involvement as a crucial factor in helping children learn better, stay in
school longer. The Administration also has worked to make post-secondary education,
whether college or training, affordable and effective.
Offered the opportunity for an Early Head Start to almost 20,000 children
Responding to research that demonstrates the importance of the first three years of life,
the Clinton Administration created the Early Head Start program for babies and toddlers so
that our most vulnerable children won't have to wait till they are 3 or 4 years old to get a
Head Start on healthy development.
Led a Renewed, Bipartisan Effort for Head Start
The Head Start reauthorization of 1994, crafted with the President's personal
commitment and sponsored by senior members of Congress, was based on the most thorough
review in the 30-year history of the program. Since 1992, 131,000 additional children have
been given the opportunity for a Head Start.
Enacted Goals 2000: Educate America Act
This comprehensive approach to supporting state and community school improvement
efforts, is based on raising academic and occupational standards so that all children can
achieve, improving teaching and expanding the use of technology. Goals 2000 is state and
locally driven with no federal mandates or control. Over 40 states are already participating,
and with the leadership of local communities, parents, teachers, and school administrators, are
developing their own strategic plans for educational reform.
Secured Reauthorization of the Elementary and Secondary School Act (ESEA)
The reauthorization of the Elementary and Secondary School Act transforms the
Federal Government's major education program to support improved student performance
through improved teaching, and enhanced parental involvement. Title I, the largest of the
ESEA programs, reaches 50,000 schools and has a direct impact on over 6 million children in
high poverty areas. By increasing school flexibility to use federal aid and supporting effective
innovations, the Reauthorization is a significant step in helping all children meet high
academic standards.
Fostering Partnerships With The Religious and Business Communities to Encourage
Family Involvement
Leaders of 33 religious organizations representing about 75 % of the religiously-
affiliated population in America expressed support for family involvement in children's
learning through signing a Statement of Common Purpose with the Administration. Chief
executive officers of large and small businesses are developing a similar statement to
encourage employers to adopt family friendly-policies and practices. Both activities are part
of the Family Involvement Partnership for Learning, a coalition of over 140 major national
organizations representing parents, schools, communities, religious organizations, and business.
Passed the School to Work Opportunities Act
School To Work promotes a new form of education for a new economy that links
learning and earning. The goals of the school-to-work movement are to provide: better
employment prospects; adults role models; and multiple pro-secondary options for all students.
Experiences are designed to develop young people's competence, confidence, and connections
that can ensure successful careers and citizenship. Employers will benefit too from access to
an educated, well-trained, and versatile workforce.
Created the Direct Lending Program
Direct Lending allows student borrowers to secure educational loans quickly and
easily, saving taxpayers billions of dollars. 104 schools participated last year, and this year
more than 1,400 schools -- the maximum allowed under the 1994 authorization -- have
committed to enrolling. The Individual Education Account simplifies borrowing, lowers
fees and interest rates, and offers more repayment choices.
Initiated a Technology and Learning Challenge
To ensure that our nation's classrooms are not left behind in the technological and
"The best thing about [School-to-work] is learning through
high school the hands-on experience that I needed in terms of
focusing on what I really wanted to do in the nursing field.
It gave me exposure and clinical experience and networking
with the professionals, and I was able to project myself in
five years that this is how I wanted to be I was
able
to
develop my skills that we really don't learn in high school
lecture classes. "
Brenda, School-to-Work Student
information revolution that is taking place, the Clinton Administration has initiated a
"Technology Learning Challenge" which asks teachers, students, local businesses,
telecommunications companies, and curriculum and learning specialists to develop and deploy
interactive learning curricula that will encourage greater learning both at school and at home.
Secured Enactment of the Educational Research and Improvement Act
By establishing the Office of Educational Research and Improvement, the Clinton
Administration has demonstrated a firm commitment to generating and expanding our
fundamental knowledge of education and lifelong learning, and aggressively promoting the
application and use of this knowledge to improve classroom practice and professional
development.
Supporting Intergenerational Education and Lifelong Learning
The Clinton Administration proposed the Adult Education and Family Literacy
Reform Act of 1995 which encourages the expansion of family literacy programs,
strengthens the relationship between family literacy and adult education, and provides
opportunities for adults to become more actively engaged in their children's learning and
improve their parenting skills at the same time.
Supporting A New Tax Deduction for Education and Training
The President proposes making tuition for college, community college, technical
school, graduate school and job-training fully deductible up to $10,000. The deduction will
be available to families earning up to $100,000, and phased out at $120,000.
Supporting Skill Grants
By consolidating some 70 federal programs for education and job training, the
President proposed to put the power to learn in workers' hands by offering low income and
unemployed workers Skills Grants -- up to $2,620 per year -- to enable individuals to take
responsibility, acquire skills, and find rewarding work.
Teaching Children After the School Day is Over
The Clinton Administration knows how important it is that young people are safe and
occupied beyond school hours. This Administration strongly supports schools and
community-based organizations staying open in the afternoon, evenings, and on weekends to
allow students, families, and community members access to recreational and educational
activities; coordinating with other agencies to provide social and health services; and forging
partnerships with businesses to provide on-the-job training, paid apprenticeships, and training
in entrepreneurial skills.
Launched the After School Demonstration Program
The After School Demonstration program expands effective after school programs
created with joint financial support from the public and private sectors, that provide safe
environments for children in public housing while permitting their parents to receive
education and training or go to work. Targeting 7- to 13-year-olds, the program helps
develop young people's skills and competencies, and assists in their social and intellectual
development.
Building Community Schools
The Community Schools initiative, enacted as part of the 1994 Crime Bill, helps
community-based organizations in low-income neighborhoods to give at-risk students positive
alternatives for after-school, weekend, and summer activities. Community schools provide
students with safe havens and teach them that drugs, gangs and guns are a dead end.
Keeping Children Well-Nourished in School
The Clinton Administration has long supported the school meals programs as critical
children's health measures. The Administration's reform plan ensures that the 25 million
children who participate on a given day have meals at school that promote their health. More
than half of these students receive meals free or at a reduced price.
Launched the School Meals Initiative for Healthy Children
The Clinton Administration is underscoring our national health responsibility to
provide students with healthy meals at school. It updates the nutrition standards school
meals must meet to reflect the new Dietary Guidelines for Americans, and offers schools new
meal planning options to meet these standards, including a flexible system of meal planning
based on nutrient analysis.
Established "Team Nutrition"
The Administration recognizes that enacting policies to update standards will not
accomplish this change alone. Team Nutrition is designed to back up the new policy with
the skills and motivation necessary SO that children can choose and enjoy a healthy meal.
Through coordinated nutrition education, and training and technical assistance, implemented
through public-private partnerships, Team Nutrition will bring to life the promise of healthy
children.
Ho
ME
"I'd just like to thank-you for giving school students
around the U.S. a better, healthier lunch. Thank-you again
Home
for the idea." Camille Ashley Hardiman, Student at
is the
Cresthaven Elementary School, Silver Spring, MD
place
where
childr
en's futures are shaped and molded -- where they get the love, guidance and support that will
be the foundation for their happiness and success as adults.
The Clinton Administration is committed to supporting and strengthening families in the
home, by ensuring the safety of children and all family members and enhancing parents'
ability to create stable and nurturing environments. This Administration wants to make sure
that families can resolve crises, connect with necessary services, and live healthy, fulfilling
and productive lives. This deep commitment to the Home is evident in many of the Clinton
Administration's initiatives
Making Sure Both Parents Support Their Children
The Clinton Administration believes that both mothers and fathers should give emotional and
financial support to their children as much as possible. In 1992, 11.5 million families with
children had a parent who was not living in the home, but only 6.2 million (54%) of the
custodial parents had a child support agreement. The Clinton Administration is taking action
to increase child support collections by $24 billion in the next 10 years.
Strengthening the Role of Fathers in the Family
On June 16, 1995, President Clinton instructed every Federal Agency to review its
program, policies and initiatives that pertain to families and devise methods of promoting
greater involvement of fathers in the family, as breadwinners, as care-takers and as active
supporters of their children's social and emotional success.
Increased Child Support Collections
In 1994, the federal-state child support enforcement system collected a record $10 billion
from non-custodial parents, an increase of 25% from 1992. A record $703 million in
delinquent child support for 1993 was collected by intercepting federal income tax refunds of
parents owing past-due child support -- 13 % more than in 1992.
Improving Paternity Establishment
Already, the Clinton Administration has proposed, and Congress has adopted, a requirement
for states to create proactive hospital-based paternity establishment programs.
Leading by Example
On February 27, 1995, President Clinton signed an executive order to make the federal
government a model employer in the area of child support enforcement. It requires all
federal agencies, including the Armed Forces, to cooperate fully in efforts to establish
paternity, and to ensure that children of federal employees are provided the support to which
they are legally entitled. Under the Clinton Administration, for the first time ever, we now
have a child support enforcement plan that describes the broad directions and aspirations of
the program.
Creating Safe and Supportive Homes For Families And Children
The Clinton Administration is committed to making homes safe and secure for children and
all family members, and there is much work to be done. In 1993, nearly 3 million children --
4% of America's children -- were the subjects of abuse and neglect reports, an increase of
almost 25% since 1988. In addition, it has been estimated that about 2.1 million women were
victims of domestic violence each year from 1978 to 1982. When children witness violence
in the home they have been found to suffer many of the negative symptoms that are
experienced by children who are directly abused.
Passed Bi-Partisan Legislation to Strengthen Families and Prevent Child Abuse and
Neglect
The Clinton Administration passed the comprehensive Family Preservation and
Support program -- the first Federal investment in prevention in the child welfare system in
more than a decade. With Federal help and support, states have been able to use these
This year the City of Baltimore, Department of Social Service's "Mother of the Year Award" will
be awarded to a mother who, with the assistance of the agency's Families Now Program, overcame
a history of substance abuse to regain custody of her children. They are celebrating their second
year as a family. She has learned sign language to communicate with her youngest son, as well as
gained the parenting skills to nurture and support two of her children who were victims of abuse.
She has turned her struggle into a success and is now a mentor for others.
resources flexibly and creatively to bring together the services families need.
Increasing The Number of Children Who Are Adopted
The Administration is ensuring that states make full and effective use of the Adoption
Assistance program, which provides critical economic support to families who adopt special
needs children. In addition, the Administration is committed to fully enforcing the
Multiethnic Placement Act, whose non-discrimination and recruitment provisions should
increase the number of children who are adopted.
Improving Efforts to Combat Domestic Violence
The Violence Against Women Act , enacted as part of the 1994 Violent Crime
Control Act, promotes a coordinated approach to dealing with violent crimes against women -
- by encouraging cooperation between law enforcement and victim advocates, and
institutionalizing collaborative efforts at the state and local level. VAWA provides $1.6
billion over the next six years for police, prosecution, prevention, and victim service
initiatives in cases involving sexual violence and domestic abuse. The Administration is
working to coordinate child abuse and family violence programs to improve services to
families where both child abuse and spouse/intimate abuse are present.
Making Sure More People with Developmental Disabilities Can Live At Home
For the first time in our nation's history, every state has reduced the number of people
with developmental disabilities living in state institutions, while increasing the number of
people living in community housing. From 1992 to 1994, a total of 45 state institutions were
closed -- less than 6 has been closed in the previous decade. More than 40 states now have
family support legislation and program to help families care for children with developmental
and other disabilities so they can, among other things, be involved in regular classrooms in
their own communities.
Helping Americans Own A Home Of Their Own
Owning your own home is part of the American Dream, and the key to personal financial
security. While the national home ownership rate rose from 43 % of all households to 65 %
between 1940 and 1980, since 1980, the overall ownership rate has declined to a current rate
of about 64 %. While this rate has been increasing in the past 2 years, the Nation's home
ownership rate is still well below its historic peak. The Administration has been working to
make it easier for more Americans -- especially young families and low income families-- to
own their own homes.
Launched a National Home Ownership Campaign
In May 1995 President Clinton presented the National Home Ownership Strategy:
Partners in the American Dream which represents an unprecedented collaboration of public
and private housing industry organizations to reach an all-time high national home ownership
level of 67% -- up to 8 million additional homeowners -- by the year 2000.
The Joint Ministries Project, a group of inner-city Minneapolis churches and
community organizations, set out to make Minneapolis a "city of homeowners." The
organization's housing development arm, Damascus Development Corporation, secured
a revolving line of credit with TCF Bank to purchase and rehabilitate up to 50 HUD-
owned vacant and boarded-up properties. For rehabilitation, Damascus contracts with
a development company that uses subcontractors from the local area. Residents lease
the rehabilitated homes from Damascus, with a portion of their rent escrowed and held
for future purchase of the property. Fannie Mae purchases mortgages upon completion
of rehabilitation and GE Capital provides needed mortgage insurance.
Helping Parents as Children's First and Foremost Teachers
The Administration recognizes the critical role families play in students' learning. Research
has shown that factors over which parents can exercise control -- school attendance, reading in
the home, and television watching -- account for 90 percent of students' test score differences.
Promoting School-Parent Compacts
School-parent compacts encourage parents and schools to work together by acknowledging
their mutual responsibilities for improving student learning. Title I of the new Elementary
and Secondary Education Act will foster school-parent compacts in at least half the nation's
schools.
Supporting Parent Information and Resource Centers
The Goals 2000: Educate America Act provides funds to state and local partnerships to
begin family information centers throughout the country to help parents help their children
learn.
Creating the Family Involvement Partnership for Learning
The Administration has launched a Family Involvement Partnership for Learning Initiative
that links the efforts of organizations and individuals to promote the mutual responsibilities of
schools, families, and the wider community in developing successful students. More than 140
national parent, community, educational organizations and religious groups have signed on to
the Partnership.
Launched A Summer Reading Initiative To Help Students Build Their Communications
Skills
Ten national organizations signed on to the READ*WRITE*NOW! initiative
promote reading and writing especially during the summer when there is a drop-off in reading
and writing. The initiative encourages reading partners -- parents, recreation directors, senior
citizens, and older students -- to work with young children on challenging and enjoyable
reading and writing activities this summer and throughout the school year.
COMMUNITY
Communities are the nurturing place for families and children. Strong communities help
families raise their children in safe and healthy environments. The Clinton Administration
has been a leader in helping communities develop resources, skill-building opportunities and
support systems for children and families -- creating the conditions in which people can shape
their own futures.
Creating Healthier Communities
The Administration is dedicated to making Americans and their communities healthier -- by
increasing the number of children who are adequately immunized and helping make sure that
families eat healthy and well-balanced diets.
Launched a National Childhood Immunization Campaign
Childhood Immunization was one of the earliest priorities of the Clinton
Administration. The comprehensive Childhood Immunization Initiative takes aim at a
broad range of problems that lead to gaps in immunization. The goal of the initiative is to
ensure that by the year 2000, at least 90% of all 2-year-olds are fully vaccinated.
Working with Communities to Improve Nutrition
The Team Nutrition initiative is improving the health and education of children
through innovative public and private partnerships that promote food choices for a healthful
diet through the media, schools, families, and the community. A key component of this
effort is a series of Team Nutrition Training Grants, which will be distributed to assist states
in developing a sustainable infrastructure of nutrition training programs.
Reforming Food Stamps to Serve More People More Efficiently
The Clinton Administration's Food Stamp reform plan will give States flexibility,
modernize benefit delivery, and stress personal responsibility. The plan is a responsible
alternative to block grants that will return the program to its nutrition roots so that it better
serves American children and families, and will ensure that benefits are issued and used
properly.
Increased WIC Participation While Pursuing Cost-Containment Measures
The Clinton Administration has added more than one million participants to the
Women Infants and Children program since FY 93 -- an 18 % increase; increased funding
to improve WIC's infrastructure in the WIC Reauthorization; and have aggressively pursued
cost containment initiatives, such as infant formula rebates.
Creating Safer Communities
Communities should be places where parents and children feel safe and secure and where people
work together to create jobs and new businesses. Yet too many communities across America hold
few if any opportunities for jobs and economic success. Tragically, many of our communities are
also unsafe. Nearly 3 million thefts and violent crimes occur on or nea r school complexes every
year. Transportation accidents kill 3,200 children a year. The Clinton Administration is working to
make communities safer, happier places through anti-crime initiatives, economic development, and
transportation safety campaigns.
Passed the Toughest, Smartest Crime Bill in History
The Violent Crime Control and Law Enforcement Act of 1994, passed with bi-
partisan support, has put 100,000 more police on the street in community policing, and includes
tough new punishments and more prison cells to help keep criminals behind bars. It sends a strong
no gangs, guns and drugs message to the 6% of young criminals who commit a majority of serious
crimes. The act also bans the 19 deadliest assault weapons and their copies, but specifically protects
more than 650 legitimate sporting weapons.
Rebuilding Distressed Communities by Helping People Help Themselves
The President secured passage of the Empowerment Zones and Enterprise
Communities legislation, giving $2.5 billion in tax incentives and $1.3 billion in flexible grants to
spur local communities to address barriers to economic growth. He has also created a network of
Community Development Banks and Financial Institutions -- which has already appropriated
$125 million in 1995 -- whose primary mission is to lend, invest, and provide basic banking services
in low- and moderate-income communities.
Making Schools Safe and Drug-Free
New legislation addresses the National Education Goal to create safe, disciplined, and
drug-free schools. The Safe and Drug-Free Schools and Communities Act supports comprehensive
strategies that link schools and communities in drug and violence prevention efforts.
Launched the "Moving Children Safely" Transportation Safety Campaign
In an effort to heighten awareness on transportation safety for children, the
Administration held a Child Safety Conference to forge partnerships with safety professionals;
convened Blue Ribbon Commission on child safety seats; and conducted a public service campaign,
"Always Expect a Train" to warn of the dangers of highway-rail grade crossings and trespassing on
railroad property. Additionally, over 200,000 child safety seats for needy families are being
purchased as a result of a settlement with General Motors.
Building Youth-Focused Community Policing
The Clinton Administration is building on the addition of 100,000 new law enforcement
officers on the street by assisting the cops in working closely with social service agencies, schools,
and community residents in better addressing the needs of children.
Launched the Safe Futures Program to Reduce Youth Violence and Delinquency
The Clinton Administration's new SafeFutures program supports comprehensive, inter-
disciplinary efforts in communities that establish a continuum of care, prevent delinquency and
reduce youth violence.
"Pulling America's Communities Together" To Stop Violence
The Clinton Administration's PACT project is providing intensified support to four areas
of the country to develop broad-based, fully coordinated local and statewide anti-violence initiatives
that work strategically to secure community safety.
Passed the Youth Handgun Act
As part of its 1994 Crime Act, the Clinton Administration passed the Youth Handgun
Safety Act. To assist state and local jurisdictions in implementing the Act, the Administration is
developing model youth handgun legislation for the states and is working closely with Governors,
Attorneys General, and State Legislators to implement it.
Created Regional Advocacy Centers to Assist Victims of Child Abuse
In 1994, the Clinton Administration created four regional children's advocacy centers
to help coordinate the judicial and social service systems' response to victims of child abuse. The
centers function as clearinghouses, distributing resource materials and tools, and providing training
and technical assistance.
Provided Incentive Grants for Local Delinquency Prevention Programs
With the support of Congress, the Clinton Administration has provided funds for
communities in every state to participate in intensive strategic planning in the area of delinquency
prevention.
Enabled Public Housing Residents to Play a More Active Role in Their Communities
The new Tenant Opportunity Program supports public housing resident initiatives like
starting tenant patrols; operating resident-owned businesses and economic development projects;
developing child care services; and operating youth crime and drug prevention programs.
Created Operation Safe Home
To combat violent crime and white collar crime in public and assisted housing, the
Administration has crafted an aggressive interagency effort -- Operation Safe Home. Between
February 1994 and February 1995, local and federal law enforcement agents working in partnership
have arrested over 3,000 individuals, most notably drug and weapons violations, and seized over
$1.5 million in drugs, $480,000 in cash and 335 weapons.