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Withdrawal/Redaction Sheet Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001. fax re: political (6 pages) 06/29/2000 Personal Misfile COLLECTION: Clinton Presidential Records First Lady's Office Melanne Verveer OA/Box Number: 23249 FOLDER TITLE: HRC Accomplishments [binder] [1] 2013-0534-S rc1715 RESTRICTION CODES Presidential Records Act [44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] P1 National Security Classified Information [(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office [(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA] b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA] b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. Files of Melanne Verveer, Assistant to the President and Chief of Staff to the First Lady Box 3: Miscellaneous Archived from OEOB 100 by Bonnie Brady on January 12, 2001 Reinhold, Niebuhr: A Biography, Richard Fox (autographed) The Book of Lights, Chain Potok (autographed) Years of Promise, Carnegie Corporation of New York (autographed) On the Edge: The Clinton Presidency, Elizabeth Drew (autographed) The Essential Haiku, Robert Hass (autographed) Heading South, Looking North, Ariel Dorfman (autographed) Interoffice Memorandums, 1993 President Clinton's Statements on the Arts - Arts U.S. Olympic Team Media Guide, Lillehammer '94 The Official Olympic Program, Lillehammer '94 HRC Accomplishments Binder Residence Notebook The English Country House, Fred Maroon The Supreme Court of the United States, Fred Maroon HRC Correspondence, copies of letters (2 binders) Enclosures Oversize Attachments filed in # 23249 19632 HRC ACCOMPLISHMENTS OAH d S S I Clinton Presidential Records Digital Records Marker This is not a presidential record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff. This marker identifies the place of a tabbed divider. Given our digitization capabilities, we are sometimes unable to adequately scan such dividers. The title from the original document is indicated below. HRC Record Divider Title: Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001. fax re: political (6 pages) 06/29/2000 Personal Misfile COLLECTION: Clinton Presidential Records First Lady's Office Melanne Verveer OA/Box Number: 23249 FOLDER TITLE: HRC Accomplishments [binder] [1] 2013-0534-S rc1715 RESTRICTION CODES Presidential Records Act - |44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] P1 National Security Classified Information [(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office [(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA] b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA] b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. 10/06/00 08:06 FAX NATL ECONOMIC COUNCIL US 003 BACK-UP FOR HILLARY'S TOP TEN 1) Adoption and Foster Care - (also see attached narrative) Passage of the Adoption and Safe Families Act of 1997 - Prevents children from languishing in foster care, speeds up adoptions, removes institutional barriers to adoption, and rewards states that do a good job moving children from foster care to adoption. Result: This year, more than 40,000 children will move from foster care to adoption- a 46 percent increase in adoptions off of the foster care roles since 1996. Passage of Foster Care Independence Act of 1999 - Assists older teens as they transition into independent living by providing them with tools to succeed, including access to health care, better educational opportunities, training and housing assistance, and counseling Made Adoption More Affordable In 1996, the First Lady helped to pass an adoption tax credit for families who adopt. Passage of Multi-Ethnic Placement Act- Works to remove race or ethnicity as a barrier to adoption. 2) Child Care - (also see attached narrative) Doubled the Number of Working Families Receiving Child Care Subsidies -Expect to receive President's full budget request of $2 billion in FY 2001. If Congress does indeed appropriate the President's request, the program will be able to serve 2.2 million children in 2001 combined with child care funds in welfare reform. Welfare reform- The First Lady was the Administration's most vocal advocate for ensuring that child care was part of the welfare reform bill. As a result, child care is an allowable expense under TANF and the Child Care Development Block Grant has more than doubled. Ensured after-school opportunities for thousands of children - This year the 21st Century Community Learning program received $453 million and is serving 850,000 children. The President has requested $1 billion for FY 01, which will help communities to serve 2.5 million- far exceeding the goal of one-half million children per year. 3) Health Care - Expanding Coverage Passage of the Health Insurance Portability and Accountability Act (Kennedy- Kassebaum) Ensures that all Americans can move form job to job without losing their health insurance and can receive health insurance despite pre-existing conditions. Enactment of Mental Health Parity- Helps eliminate discrimination against those with mental illnesses by prohibiting health plans from setting separate lifetime and annual limits for mental health coverage. 4) Gulf War Veterans - Health Issues (also see attached narrative) Investigated the government's efforts Met with veterans and government officials to determine if the government was doing all it could to address the veterans' serious health needs. Helped Create an independent advisory committee The First Lady's recommendation led to the appointment of the Presidential Advisory Committee on Gulf War Veterans' Illnesses, and she testified at its first meeting. 1 10/06/00 08:07 FAX NATL ECONOMIC COUNCIL 004 Made the federal government responsive to the needs of Gulf War veterans- Improved the health care they receive, expanded access to compensation, and ensured that the lessons learned are implemented for future deployments. Her work has resulted in 192 research projects to identify possible causes of the undiagnosed illnesses, determine appropriate treatments, and develop ways to protect personnel on future deployments. Gulf War veterans have received more than 117,000 free medical exams, and more than 143,000 disability claims have been approved. 5) CHIP Enactment of the Children's Health Insurance Program - CHIP is the single largest investment in health care for children since 1965 and now provides health insurance for two million low income children who would otherwise be uninsured and will reach 5 million children when fully enacted. Improved Outreach to Insure More Children - The First Lady recognized that one of the key reasons that so many eligible children go uninsured is a lack of awareness of Medicaid and CHIP options and has been leading efforts to improve outreach to parents and enroll more children. She worked with the public and private sector to develop and launch Insure Kids Now, an outreach campaign. 6) Mammograms - (see attached narrative on Breast Cancer) Chaired the Medicare Mammography Campaign- The First Lady traveled the country, conducting "listening sessions" with older women to learn about the barriers they faced to getting mammograms. She worked with the public and private sector to increase awareness of the Medicare benefit and to encourage women to obtain mammograms. Expanded Medicare Coverage of Mammograms- Because of Hillary's strong leadership, the President proposed, and Congress adopted, the expansion of Medicare coverage to help pay for annual mammogram screenings for all Medicare beneficiaries age 40 and over. Under this new benefit, which was enacted as part of the Balanced Budget in 1997 and became available January of 1998, Medicare waives the Part B deductible for screening mammograms. Helped to Ensure that Mammograms are Reliable As a result of the First Lady's work, the Administration is developing new regulations to ensure the safety and quality of mammograms. 7) Childhood Immunization Launched the Child Immunization Initiative- This initiative ensures that that vital children's vaccines are available and affordable. As a result, childhood immunization rates for 1999 are at an all-time high- 90 percent for toddlers. 8) Research on Diseases Focused Attention on Pediatric AIDS- The First Lady inaugurated a public outreach campaign. Promoted Research and Funding on Specific Children's Health Issues - The First Lady worked to secure increased funding for Epilepsy and Juvenile Diabetes. Developed a comprehensive childhood asthma initiative- The First Lady launched this initiative to study the environmental causes of asthma, improving treatments, and promoting awareness. Championed breast cancer research- The First Lady has been the Administration's chief advocate for increased research on breast cancer. During this Administration, 2 10/06/00 08:07 FAX NATL ECONOMIC COUNCIL 0 005 funding for breast cancer research has more than doubled - from $283 million to a projected $660 million in Fiscal Year 2001. 9) Community Service- (see attached narrative on youth) Advocated for and Advised on the Administration's National Service Initiative- - The First Lady's key policy advisor at the start of the Administration headed the effort to develop the National and Community Service Trust Act of 1993, which included the successful AmeriCorps program. Launched the Successful AmeriCorps Program - Since the launch of AmeriCorps five years ago, more than 150,000 Americans have served on the front lines in hard- pressed neighborhoods- tutoring in schools, responding to natural disasters, helping to make our streets safer, building homes, and more. In fact, more Americans have served in AmeriCorps in the-last five years than have served in the entire history of the Peace Corps. Raised Visability and Supported Funding for Service Learning in Schools- Created a National Leader Schools Initiative awarding schools with exemplary service learning programs and expanded funding for service learning through the Corporation for National Service. 10) Historic Preservation - Save America's Treasures Launched Historic Effort to "Save America's Treasures - - For the past two years, the First Lady has worked hard to gain public and private funding to save some of America's greatest treasures in order to preserve the nation's heritage and culture for future generations. This hard work has led to over $200 million in investment for historic preservation - 60 percent public money, 40 percent private money. Save America's Treasures is the largest, single historic preservation effort in the history of the United States. Grants in New York have Saved Historic Sites - Thousands of dollars in grants to projects in New York have: (1) saved and restored the Harriet Tubman Historic Site; (2) the Tenement at 97 Orchard Street in New York City, which is a museum that interprets the home and community life of urban, working class and poor immigrants; (3) the Metropolitan Opera Radio and Television Archives in New York City; (4) the Babe Ruth Scrapbooks, National Baseball Hall of Fame in Cooperstown; (5) and the Ellis Island and Statue of Liberty restoration project. 3 WHAT HAS HILLARY DONE TO HELP NEW YORKERS? I. SUPPORTING NEW YORK'S WORKING FAMILIES Hillary has been a voice for all of America's working families and New York's families have benefited: Expanded Head Start to serve More of New York's Children. Hillary Clinton has been one of the most vocal advocates for expanding Head Start and her work to push for increased funding has paid off. Since 1993, funding has doubled for this national program which provides comprehensive developmental services for America's low-income preschool children ages three to five and social services for their families. Over 45,000 New York Children were enrolled in Head Start in 1999 alone. And, this year, New York will receive $344.6 million in Head Start funding, an increase of $162.5 million over 1993. Improved Access to Affordable and Quality Child Care. Hillary Rodham Clinton has fought hard to make sure that working parents receive support so that they have access to quality child care opportunities for their children. The Child Care and Development Block Grant and child care funds provided through welfare reform enable States to provide federal child care subsidies for families, thereby enabling low-income parents to work. This year, New York received more than $245 million in federal funds to provide New York's working families with greater access to affordable child care. A $500 Child Tax Credit to Help Families Raising Children. To make it easier for families to raise their children, the Administration fought for and won a $500 per-child tax credit for children under 17. This child tax credit is benefiting 1,727,000 families in New York. More New Yorkers Have Access to After-school Opportunities for their Children. Since 1993, the Administration's budget has moved from $1 million for after school and summer school opportunities to $453 million this year and a proposed $1 billion in FY 01. Hillary Rodham Clinton has continually called attention to the fact that with more working parents, we need more opportunities for children to participate in safe and enriching after-school opportunities. This year, New York is receiving nearly $18 million in new grants to fund 22 new after-school programs to keep New York's children safe and engaged in the after- school hours. II. EXPANDING ACCESS TO EDUCATION FOR NEW YORK'S CHILDREN AND SUPPORTING NEW YORK'S MOST VULNERABLE CHILDREN Hillary has been a champion for providing high quality public education for all children and New York's children have benefited: More High-Quality Teachers with Smaller Classes for New York's Schools. Last fall, Hillary went to Capitol Hill to send a message that the Administration would not accept a budget that did not include critical funding to reduce overcrowded classrooms. Thanks to the Class Size Reduction Initiative, New York received $104.5 million in 1999 to hire approximately 2,688 new well- prepared public school teachers and reduce class size in the early grades. This year, with Hillary's leadership, the Administration secured funding for a second installment of the plan, giving New York an additional $113.2 million in 2000. Opening the Doors to College for New York's Young People. This year, Hillary called on the Administration to expand efforts to make college affordable for more Americans by calling for a $30 billion College Opportunity Tax Cut. This tax cut would build on the Administration's HOPE scholarships to help make the first two years of college as universal as high school and the Lifelong Learning 1 ax Credit to help working American's continue to learn and grow. Already, 344,000 students in New York have received HOPE Scholarship tax credits and 414,000 students in New York have received the Lifelong Learn tax credits. Supporting Children in Foster Care and Encouraging Adoption. Hillary has been the Administration greatest champion on efforts to make foster care work better, to find and assist adoptive families, and to break down barriers to adoption. From 1996 to 1998, the number of adoptions nationwide rose 29 percent - from 28,000 to 36,000 - and is on track to meeting the Administration's goal of 56,000 adoptions in 2002. In 1997, the President signed the Adoption and Safe Families Act, which expedited permanent placement decisions for children, ensured health insurance coverage for all special-needs children in subsidized adoptions, and created an incentive program for states to increase adoptions. New York was one of the States that received the first reward for increasing adoptions from foster care. Hillary also fought hard to make sure that young people who leave foster care get the tools they need to make the most of their lives. Championed by Hillary, the Foster Care Independence Act of 1999 was signed by the President in December. It empowers those leaving foster care by providing them with better educational opportunities, access to health care, training, housing assistance, counseling and other services. III. INVESTING IN NEW YORK'S HEALTH Making Sure New York's Children Receive Health Care. In 1997, the Administration passed the largest single investment in health care for children since 1965 - an unprecedented $24 billion over five years to cover as many as five million children throughout the nation. This investment guarantees the full range of benefits that children need to grow up strong and healthy. Two million children nationwide have health care coverage thanks to the President's plan, including 521,301 in New York. Supporting the Nutritional Health of New York's Women and Children. Hillary has fought long and hard to raise awareness about the importance of improving the nutrition of low-income mothers and their children. Through the Special Nutrition Program for Women, Infants, and Children (WIC) nearly 480,000 New York women, infants, and children received critical health and food assistance in 1999 through the $274 million in total WIC grant funding. More Toddlers in New York are Being Immunized. As a result of the Administration's 1993 Childhood Immunization Initiative, spearheaded by Hillary Rodham Clinton, childhood immunization rates have reached an historic high. According to the CDC, 90% or more of America's toddlers received the most critical doses of each of the routinely recommended vaccines in 1996, 1997, and again in 1998 -surpassing the Administration's 1993 goal. In New York in 1998, 96% of two-year olds received the vaccines for diphtheria, tetanus, pertussis; 93% received the vaccine for pono, 95% received the Vaccine for measles, and 95% received the vaccine for Haemophilus influenzae B, the bacteria causing a form of meningitis. No Patients Bill of Rights Means Over 7 Million New Yorkers Cannot Be Assured of Patient Protections. Even if New York enacted all the protections in the Patients' Bill of Rights, 7,570,000 people in New York cannot be assured they have the comprehensive patient protections recommended by the President's Advisory Commission. This is because the Employee Retirement Income Security Act (ERISA) may preempt state-enacted protections. That is why Hillary Rodham Clinton has called on Congress to pass a federally enforceable patients' bill of rights so that everyone enrolled in managed care may have a basic set of protections. Notably, 3,800,000 New York women are in ERISA health plans and are therefore not necessarily protected. Women are particularly vulnerable without these protections because they are greater users of health care services, they make three-quarters of the health care decisions for their families, and they have specific health care needs addressed by a patients' bill of rights. TO: Neern FROM: Ann OL Neem- Attached pls. find instial tulhong points ch that HRC has done for New whinks Children and funilies. I'm sure we could add more but these are programs and policis directly tied to HRC. Pls. let me nnw it this is helpful w if you was to add mor. Thinks -AOL NOT FOR DISTRIBUTION Hillary Rodham Clinton Biographical Data Born: October 26, 1947, in Chicago, Illinois Husband: President William Jefferson Clinton Daughter: Chelsea Victoria Clinton First Lady of the United States The White House Washington, D.C. 20500 EDUCATION: B.A. Wellesley College, 1969 J.D. Yale Law School, Yale University, 1973 LAW PRACTICE AND PROFESSIONAL ASSOCIATIONS: Admitted to Arkansas Bar, 1973 U.S. District Court (eastern and western districts), 1973 U.S. Court of Appeals (8th Circuit), 1973 U.S. Supreme Court, 1975 Children's Defense Fund, Cambridge, Massachusetts and Washington, D.C., and Carnegie Council on Children, New Haven, Connecticut, 1973-74 Counsel, Impeachment Inquiry Staff, Judiciary Committee, United States House of Representatives, Washington, D.C., 1974 Chair, American Bar Association Commission on Women in the Profession, 1987-91 Chair, Legal Services Corporation, Washington, D.C., 1978-80, Member, Board of Directors, 1977-81 Partner, Rose Law Firm, Little Rock, Arkansas, 1977-92 LAW TEACHING: Assistant Professor of Law and Director of the Legal Aid Clinic, University of Arkansas School of Law at Fayetteville, 1974-76 Assistant Professor of Law, University of Arkansas School of Law at Little Rock, 1979-80 For internal use only - not for public distribution 2 PUBLICATIONS: "Children Under the Law," Harvard Educational Review, January, 1974 "Children's Policies: Abandonment and Neglect," 86 Yale Law Journal 1522 (1977) (review of Gilbert Y. Steiner: The Children's Cause, 1976) "Handbook on Legal Rights for Arkansas Women," Carolyn Armbrust [et al.], a project of the Governor's Commission on the Status of Women, 1977, 1987 editions "Children's Rights: A Legal Perspective," Children's Rights, Teachers College Press, New York, 1979 "Teacher Education: Of the People, By the People and For the People," Beyond the Looking Glass: Papers from a National Symposium on Teacher Education Policies, Practices, and Research, March, 1985 and Journal of Teacher Education, January-February, 1985 "In France, Day Care is Every Child's Right," Editorial, The New York Times, April 7, 1990 "Hillary: What plan will do for you," USA Today, September 21, 1993 Foreword, The First Ladies, by Margaret Klapthor and Allida Black, White House Historical Association, 1994, 1995, and 1999 editions Foreword, The White House: An Historic Guide, White House Historical Association, 1994, 1995, and 1999 editions "The President Says, 'We Must.' We Will. Seize the Moment: Provide Health Coverage for All, Guaranteed," Roll Call, June 13, 1994 "Life Lessons...; Memories of Virginia Kelley, President Bill Clinton's Mother," Redbook, July 1994 "Raising Chelsea," Child Magazine, October, 1994 Interview, A Woman's Place: The Freshman Women Who Changed the Face of Congress, by Marjorie Margolies-Mezvinsky and Barbara Feinman, 1994 "The Fight over Orphanages," Newsweek, January, 1995 "Spirit of Compassion for Children Attacked," Editorial, The Arizona Republic, March 16, 1995 "What Can We Do, What Must We Do," Parenting Magazine, June/July, 1995 "Investing in Sisterhood; An Agenda for the World's Women," Outlook, The Washington Post, May 14, 1995 Remarks by First Lady Hillary Rodham Clinton: United Nations Fourth World Conference on Women, September 5-6, 1995 "Talking It Over," Syndicated column, 1995-Present Opening Statement, The White House Collection of American Crafts, by Michael Monroes, Harry Abrams, Inc., 1995 It Takes A Village and Other Lessons Children Teach Us, Simon and Schuster, January 1996 "Time to Act on Behalf of Women Everywhere," The Journal of Intergroup Relations, Summer 1996 "Giving Every Child A Chance," Exceptional Parent, June 1996 Foreword, Smithsonian Book of First Ladies, edited by Doris Faber and Edith P. Mayor, Henry Holt & Company, Inc., 1996 For internal use only - - not for public distribution 3 "Comfort and Joy: The First Mom Suggests Reading as an Easy Way to Help a Baby's Brain Grow," Viewpoint, Time Magazine, February 3, 1997 Remarks and commentary by First Lady Hillary Rodham Clinton: Africa, March 1997 "Doing the Best for Our Kids," Your Child's World Special Issue, Newsweek, Spring/Summer 1997 "Our Chance for Healthier Children," Op-Ed, The New York Times, August 5, 1997 "Report from the Road," Newsweek, November 24, 1997 Remarks and commentary by First Lady Hillary Rodham Clinton: Central Asia, Russia, Ukraine, November 1997 Remarks by First Lady Hillary Rodham Clinton in commemoration of the 50ᵗʰ Anniversary of the United Nations General Assembly Adoption and Proclamations of the Universal Declaration of Human Rights, December 10, 1997 Remarks and Commentary by First Lady Hillary Rodham Clinton: Vital Voices, 1997-1999 Dear Socks, Dear Buddy: Kids' Letters to the First Pets, Simon and Schuster, 1998 "Remembering Virginia," Ladies Home Journal, May 1998 "Going Private: Vouchers are not the answer to public-school woes," Op-Ed, The Charleston Gazette, June 15, 1998 "Holding up the sky; Hillary Clinton's Views on the Chinese Women," Harper's Bazaar, October 1998 Introduction, We Remember: Women Born at the Turn of the Century Tell the Stories of Their Lives in Words and Pictures, by Jeanne Marie Laskas, William Morrow & Co., 1999 Foreword, The Person Who Changed My Life: Prominent Americans Recall Their Mentors, edited by Matilda Raffa Cuomo, Carol Publishing Group, 1999 "Let's Celebrate Together the 200th Anniversary of the White House," Parade Magazine, July 4, 1999 "50 Years Of Progress: Moving Toward Full Human Rights And Economic Empowerment For Women," Chicago Policy Review, Volume 3, Number 1, Fall 1999 "A Tribute to Archbishop Desmond M. Tutu and Dr. Alexander L. Boraine," Annual Survey of American Law, 1999 Volume, Issue 1 Foreword, National Landmarks, America's Treasures: The National Park Foundation's Complete Guide to National Historic Landmarks, by S. Allen Chambers, Jr., John Wiley & Sons, Inc., 2000 "To the Reader" Message, Common Interest, Common Ground, by Shirley Sagawa and Eli Segal, Harvard Business School Press, 2000 Foreword, Witness to Genocide: Children of Rwanda: Drawings by Child Survivors of the Rwandan Genocide of 1994, by Richard A. Salem, Friendship Press, 2000 Afterword, Beatrice's Goat, by Page McBrier, Simon and Schuster, 2000 "Parenting a Teen. Newsweek, May 8, 2000 HONORS AND AWARDS: For internal use only - not for public distribution 4 Honorary Doctor of Law: University of Arkansas at Little Rock, 1985 Arkansas College, Batesville, Arkansas, 1988 Hendrix College, Conway, Arkansas, 1992 University of Michigan, 1993 University of Pennsylvania, 1993 University of Sunderland, England, 1993 University of Illinois, 1994 San Francisco State University, 1995 University of Minnesota, 1995 Goucher College, 1998 Howard University, 1998 National University of Ireland, Galway, 1999 Honorary Doctor of Public Service: George Washington University, 1994 University of Maryland at College Park, 1996 Honorary Doctor of Humane Letters: Drew University, 1996 Ohio University, 1997 Honorary Professorship: American University in Kyrgyzstan, 1997 Honorary Associate in Child, Family and Community Service: Lincoln Land Community College, 1996 Who's Who in the World, 1998 Who's Who in America, 1994-2000 Who's Who in American Law, 1994-95 Who's Who in Emerging Leaders in America, 1993-94 Who's Who of American Women, 1993-98 International Who's Who, 1993-2000 In Appreciation, Legal Services Corporation of Alabama, March 1979 Distinguished Service as Counsel, State Judicial Council of Arkansas, 1979 Woman of the Year, Arkansas Democrats, 1983 Headliner of the Year, Arkansas Press Association, 1983 Phi Kappa Phi Honors Lecture, University of Arkansas at Little Rock, 1984 Phi Delta Kappa Award for Outstanding Layman of the Year for Contributions to For internal use only - not for public distribution 5 Education, 1984 Arkansas Press Broadcasters Newsmaker of the Year, 1984 Arkansas Honor Young Mother of the Year, 1984 Esquire Magazine Register, "The Best of the New Generation, Men and Women Under Forty Who Are Changing America," 1984 Public Citizen of the Year Award, Arkansas Chapter, National Association of Social Workers, 1984 Friend of Education Award, England Education Association, March 1984 Service Award, National Organization of Child Care Workers Associations, Inc., March 1984 Outstanding Service, Pi Upsilon Chapter of Kappa Delta Pi Honor Society in Division of Education at University of Arkansas Pine Bluff, September 1984 Arkansas Bar Association and Arkansas Bar Foundation Award: "To recognize outstanding achievements as a lawyer and role model," 1985 In Honor of Contributions to Education, Southern Association of Collegiate Registrars and Admissions Officers, February 1986 Pulaski County Bar Association Lawyer-Citizen Award, 1987 Woman of Distinction Award, Arkansas Professional Women of Distinction, Presented by Worthen Bank, November 1987 Woman of Destination, Selfless Leadership in Community Activities, Florence Crittenton Home, 1987 The Best Lawyers in America, 1987, 1989-90, 1991-92, 1993-94 Friend of Pediatrics, Arkansas Chapter, American Academy of Pediatrics, 1988 Recognition of Distinguished Accomplishments in Professional and Civic Affairs, Who's Who in Society, 1988 Gayle Pettus Pontz Award, "For outstanding excellence and achievement in the legal profession," Women's Law Student Association, University of Arkansas at Fayetteville, 1989 Thanks for Vision and Leadership in Bringing HIPPY to Arkansas, HIPPY USA, September 10, 1990 Honorary Citizen, Blytheville, Arkansas, October 1990 Paul Harris Fellow, "Recognizing service above self," Rotary Club of Little Rock, 1991 Director's Choice Award, National Women's Economic Alliance Foundation, 1991 Outstanding Shape of Arkansas Lawyer-Citizen Award - recognition of contribution to the legal profession, Arkansas Bar Association and Arkansas Bar Foundation, 1991-92 100 Most Influential Lawyers in America, National Law Journal, 1991, 1997 Bess Chisum Stephens YWCA Woman of the Year, "Arkansas First Lady," For Outstanding Leadership and Dedication to the People of Arkansas, 1992 Glamour Women of the Year Award, "For bringing our country's First Relationship into the nineties," One of ten women honored, 1992 ROSE (Recognition for Outstanding Service to Education) Award, University of Southern California School of Education, 1992 Outstanding Lawyer-Citizen Award, "In recognition of outstanding participation in For internal use only - not for public distribution 6 and excellent performance of civic responsibilities, and for demonstrating high standards of professional competence and conduct," Arkansas Bar Association, 1992 Commendation for Outstanding Record of Achievement, Senator Diane Watson, March 26, 1992 Honorary Secretary of State of Alabama Award, Secretary State of Alabama, May 14, 1992 President's Medal, Bank Street College, October 1, 1992 Lifetime Membership Certificate, Girl Scouts of America, December 1992 Citizen of the Year, Arkansas March of Dimes, 1993 Lewis Hine Distinguished Service Award for Lifetime Commitment to the Well-being of Children and Youth, National Child Labor Committee," January 26, 1993 Life Membership, Arkansas Business and Education Alliance Resolution, February 5, 1993 Albert Schweitzer Leadership Award, "In recognition of leadership in guiding and motivating youth," Hugh O'Brian Youth Foundation, May 10, 1993 Friend of Family Award, American Home Economics Association, June 26, 1993 The Iris Cantor Humanitarian Award, University of California at Los Angeles, "For Commitment to Women's Health Issues," July 19, 1993 Charles Wilson Lee Citizen Service Award, Committee for Education Funding, 1993 Awareness Achievement Award, National Breast Cancer Awareness Month, 1993 Recognition of Vision and Unwavering Commitment to Achieving National Health Care Reform, Service Employees International Union, Fall 1993 Key to the City of Rochester, Minnesota, September 17, 1993 Claude D. Pepper Award, The National Association for Home Care, October 19, 1993 1993 National Humanitarian Award, American Friends of Jamaica, Inc., November 13, 1993 Distinguished Service Award, National Center for Health Education, November 18, 1993 Healthcare Advocacy Award, National Symposium on Healthcare Design, November 19, 1993 Distinguished Service Award, Phelps Memorial Hospital Center, November 20, 1993 First Humanitarian Achievement Award, El Banquete del Millon y del Amor, Inc., Saint Anthony Catholic Church, November 27, 1993 National Public Service Award 1993, The Bar Association of the District of Columbia, December 4, 1993 Fannie Lou Hamer Human Rights Award, Clergy and Laity Concerned, December 16, 1993 Special Recognition for Tireless Leadership on Health Care Reform, National Farmers Union, 1994 Award for "Making a Difference for Women's Health," National Women's Law Center, 1994 Lyman J. Gage Award for Civic Achievement, The Civic Federation, 1994 OHEL's Humanitarian Award, Children's Home & Family Services, January 15, 1994 First Save Our Youth Award, Save Our Youth, January 23, 1994 Commitment to Life Award, AIDS Project Los Angeles, January 27, 1994 Distinguished Service Health Education & Prevention Award, "For efforts in focusing the nation's attention on health care and emphasizing the relationship between education and proper health care" National Center for Health Education, February 2, 1994 "Cerviel" Achievement Award, "For efforts as a woman in corporate America and For internal use only - not for public distribution 7 barrier-breaking efforts from which others have benefited," Vista magazine, February 15, 1994 California Coalition of Nurse Practitioners, Nurse Practitioner of the Year Award, February 24, 1994 Vision in Education Award, Columbus School for Girls, February 25, 1994 National Association of Cuban American Women, New Jersey Chapter, March 1, 1994 Distinguished Service in Aging Award, American Association of Homes for the Aging, March 15, 1994 First Award on Distinguished Humanism, Bragg Symposium on Humanism, All Saints Unitarian Church, March 18, 1994 First Annual Eleanor Roosevelt Freedom Fighter Award, Alachua County Democratic Executive Committee, March 21, 1994 Social Justice Award, "For efforts to ensure that every American receives proper health care," United Auto Workers, March 22, 1994 Friend of Education Award, Buffalo Teacher's Federation, Inc., March 22, 1994 Brandeis Award, School of Law, University of Louisville, April 1, 1994 Benjamin E. Mays Award, A Better Chance Inc., April 4, 1994 Ernie Banks Positivism Trophy, "Given to the First Lady for her efforts as a most productive contributor to life in America," Emil Verban Memorial Society, April 6, 1994 Humanitarian Award, Alzheimer's Association, April 11, 1994 Elie Wiesel Foundation Humanitarian Award, April 14, 1994 Leadership Award, Regional Aid for Interim Needs (RAIN), Inc., Bronx, New York, April 21, 1994 International Broadcasting Award, "For contributing to the betterment of radio and television," Hollywood Radio and Television Society, April 26, 1994 Ellen Browning Scripps Award, "To a pioneering women who has made a significant and positive difference in the life possibilities available to women," Scripps College, April 26, 1994 Legislator of the Year Award, The American Physical Therapy Association, April 27, 1994 Dr. Edward C. Mazique Memorial Award, Greater Washington Boys and Girls Club, April 27, 1994 Ollie Randall Award, National Council on the Aging, April 27, 1994 Montclair Yale Bowl Award, Yale Club of Montclair, May 1, 1994 Women of Distinction Award, Crohn's & Colitis Foundation of America, Inc., May 2, 1994 Coalition of Labor Women United, May 2, 1994 HIPPY USA Award, May 6, 1994 Women of the Year Award, Yad B'Yad Award, May 7, 1994 Distinguished Citizen Award, Coalition of Citizens with Disabilities in Illinois, May 16, 1994 C. Everett Koop Medal for Health Promotion and Awareness, American Diabetes Association, May 17, 1994 Distinguished Pro Bono Service Award, San Diego Volunteer Lawyer Program, May For internal use only - not for public distribution 8 17, 1994 Humanitarian Award, Chicago Chapter, Hadassah Medical Organization, May 26, 1994 Coalition of Labor Union Women 20th Anniversary Award "For tireless dedication on behalf of National Health Care Reform," May 20, 1994 Women of Distinction Award, National Conference for College Women Student Leaders, June 2, 1994 Women of Achievement Award, Women's Project and Productions, June 6, 1994 Girl Scouts of Illinois Crossroads Award, Girl Scouts, June 10, 1994 Barnert Hospital Award, "For outstanding service for health care reform," Board of Trustees, Barnert Hospital, Paterson, New Jersey, June 11, 1994 Mary Hatwood Futrell Award, "The award commends her efforts on behalf of education opportunity, especially for women and girls," National Education Association, June 14, 1994 Women of Achievement Award, B'nai B'rith Women, June 15, 1994 The Ellington Shield Against Hopelessness, The Duke Ellington School for the Performing Arts, June 15, 1994 Claude Pepper Award, "For recognition for her dedication to health care reform and long term care," National Association for Home Care Board of Directors, June 19, 1994 Women's Legal Defense Fund Award "Commending her work in advancing the status of women in society," June 23, 1994 Anna Eleanor Roosevelt Medallion of Honor, Alpha Kappa Alpha Sorority, July 13, 1994 William S. Hall Award, South Carolina Association of Residential Care Homes, July 25, 1994 Shining Star Award, "In recognition of her work on behalf of children, especially those with terminal illnesses," Starlight Foundation, August 2, 1994 Martin Luther King, Jr. Award, Progressive National Baptist Convention, Inc., August 12, 1994 Women of Achievement Award, Westchester Association of Women's Business Owners, September 24, 1994 Non-Profit Advocacy Award, Illinois Association of Non-Profit Organizations, October 28, 1994 Brass Ring Award, Children's Diabetes Foundation, October 28, 1994 Women's Media Group Award, "For Outstanding Leadership," Women's Media Group, November 1, 1994 Memorial Sloan-Kettering Cancer Center Medal, November 2, 1994 American Academy of Matrimonial Lawyer's Family Advocate of the Year Award, Greenfield & Murphy, November 4, 1994 Dr. Frederick D. Patterson Memorial Award, United Negro College Fund, November 5, 1994 Delta Spirit Award, Delta Sigma Theta Sorority, Inc., Los Angeles Chapter, November 10, 1994 Woman of Distinction Award, Women's League for Conservative Judaism, November 13, 1994 First Leila Robinson Award, Women's Bar Association of Massachusetts, November 17, 1994 30th Anniversary of Women at Work Award in Public Policy, National Commission on Working Women, December 6, 1994 Public Service Award, Modell's Sporting Goods Executive Offices, December 8, 1994 Boehm Soaring Eagle Award for Excellence in Leadership, National Women's For internal use only - not for public distribution 9 Economic Alliance Foundation, December 12, 1994 Pre-inaugural Award in Honor of First Ladies in Washington, Diamond Designs, December 30, 1994 Child Health Day Life Line Award, American Health Foundation, 1995 National Woman's Law Center Award, Annual Awards Dinner 1994 "For Making a Difference in Women's Health, Family Circle Woman Who Makes a Difference Lifetime Achievement Award," 1995 Top Lady of Distinction Award 1995, The Martin Luther King, Jr. Center Support Group of Southeast Texas, Inc., January 16, 1995 Award for Excellence in Communication, Capital Speakers Club, January 18, 1995 National Federation of Black Women Business Owners Black Women of Courage Award "For outstanding commitment advocacy, and support of women-owned businesses," February 8, 1995 Nurse Practitioner of the Year Award, California Coalition of Nurse Practitioners, February 24, 1995 Woman of the Year Award, Iowa City/Johnson County Senior Center, March 1, 1995 Greater Washington Urban League Award, March 8, 1995 Golden Acorn Award, Child Development Center, Bronx, New York, March 9, 1995 Servant of Justice Award, New York City Legal Aid Society, March 23, 1995 Health Educator of the Year Award, The Ryan White Foundation, April 8, 1995 Golden Image Award, Women At Work, April 9, 1995 1995 Outstanding Mother Award, National Mother's Day Committee, April 13, 1995 Eleanor Roosevelt Award, Citizen's Committee For Children of New York, Inc., April 24, 1995 1994 Annual Survey of American Law Dedication to Hillary Rodham Clinton, New York University School of Law, April 25, 1995 Certificate in Recognition of Outstanding Efforts for the People of this Country, Hadassah, Florida-Broward County Region, April 30, 1995 United Cerebral Palsy Humanitarian Award, 1995 World Health Award, American Association for World Health, World Health Day, 1995 Presidential Medal, Brooklyn College, June 1, 1995 Recognition for Efforts on Behalf of Children and Families, Upper Peninsula Children's Coalition of Escanaba, Michigan, June 2, 1995 Write Women Back Into History Award, National Women's History Project, August 26, 1995 Save the Children Service Award, September 1995 Miss America Woman of Achievement Award, September 1995 Eleanor Roosevelt Val-Kill Medal, October 1, 1995 The National Breast Cancer Coalition Leadership Award, October 26, 1995 Sisterhood Award, NAACP, November 28, 1995 Jane Matilda Bolin Award, Metropolitan Black Bar Association, December 9, 1995 Paul Harris Fellow, The Rotary Foundation, 1996 ADRA's Humanitarian Award, January 29, 1996 1996 NICHE Humanitarian of the Year Award, The Rosen Group's Buyers Market of For internal use only - not for public distribution 10 American Craft, February 11, 1996 Catherine Dunfey Award, New England Circle, February 22, 1996 Friend of Education Award, Buffalo Teachers Federation, March 6, 1996 Faith in Humanity Award, National Council of Jewish Women, March 9, 1996 Outstanding Communicator, Los Angeles Advertising Women, April 25, 1996 Anniversary Leadership Award, Center for Policy Alternatives, May 10, 1996 Key to the City of Van Buren, Arkansas, May 11, 1996 "Thank you for your commitment to America's children," National Parent Teacher Association, June 24, 1996 National Association of Elementary School Principals Distinguished Service Award, July 28, 1996 Commendation by the County of Los Angeles for supporting and recognizing an American Heritage: Crafts and their artists, September 11, 1996 Mayor's Orchid Award, West Palm Beach, Florida. "For your efforts in helping to Sculpt a Capital City." October 1, 1996 First Annual Amy Center Award, Mount Vernon, Illinois. "For your tireless efforts on behalf of children everywhere." October 9, 1996 Sticking Your Neck Out Award, Pima Council on Aging, Tucson, Arizona, October 15, 1996 Washington International School Award for Advocacy on Behalf of Young People, Washington, D.C., October 26, 1996 Outstanding Contribution Award, Florida Agricultural Mechanical University, October 30, 1996 The Diamond In The Rough Award, Young Women's Council of the Florida Agricultural Mechanical University, October 30, 1996 25 Most Influential Working Mothers, Working Mother Magazine, February 10, 1997 Grammy Award, Best Spoken Word or Non-Musical Album, National Academy of Recording Arts & Sciences, February 26, 1997 National Family Advocate Award, Parents' Plus/The Boston Parents' Paper, March 1, 1997 Public Spirit Award, American Legion Auxiliary, March 2, 1997 "Bully Pulpit" Award, The National Council for Adoption, "For advocacy on behalf of adoption especially through the Adoption 2002 Initiative." April 16, 1997 National Family Advocate Award, Parents' Plus Newspaper, April 21, 1997 Judge Lois Forer Child Advocacy Award, Support Center for Child Advocates, April 28, 1997 "Parents - As They Grow - Award: Hillary Rodham Clinton 1997," Parents Magazine, May 22, 1997 The President's Award for Distinguished Public Service, American Society for Public Administration, July 29, 1997 Honorary Title of Control House Operator, The Panama Canal Miraflores Locks, October 9, 1997 1997 Beacon Award, Trustees' Council of Penn Women, October 22, 1997 Distinguished Service to Education award, The College Board, October 28, 1997 Lifetime Achievement Award, Big Sisters Guild/Big Sisters of Los Angeles, October 30, 1997 Distinguished Service Award, Columbia University National Center on Addiction For internal use only - not for public distribution 11 and Substance Abuse, November 21, 1997 Commitment to Children Award, The Elizabeth Glaser Pediatric AIDS Foundation, December 1, 1997 Eleanor Roosevelt Living World Award, Peace Links, December 9, 1997 Friend of Children Award, Children's National Medical Center, December 16, 1997 Ronald H. Brown Bridge Builder Award, Ronald H. Brown Foundation, 1998 Lincoln Medal, Ford's Theatre, February 8, 1998 Decade of the Brain Award, Society for Neuroscience, March 18, 1998 T. Berry Brazelton Leadership Award, Brazelton Foundation, March 28, 1998 1998 Great Friend to Kids Award, Association of Youth Museums, May 8, 1998 United Arab Emirates Health Foundation Prize, World Health Organization, May 14, 1998 Friend of Education Award, Educational Press Association of America, June 5, 1998 1998 Eleanor Award, Woman's National Democratic Club, June 10, 1998 The Burst: Energy, innovation, excitement turned into ACTION, Jumpstart, June 18, 1998 Top 10 Most Influential Women, Civil Service Employees Association, Seneca Falls, New York, July 16, 1998 Beverly Minkoff Award, Women's American ORT, July 17, 1998 Honored for "all your extra efforts on behalf of the American Cancer Society," American Cancer Society, September 10, 1998 Edmund S. Muskie Distinguished Public Service Award, Center for National Policy, September 17, 1998 "Parents 1998 Child Care Awards," Parents Magazine, September 23, 1998 Honored for "exemplary leadership on behalf of children and families," National Committee to Prevent Child Abuse, October 6, 1998 Foreign Policy Association Medal, Foreign Policy Association, October 19, 1998 Annual Award of the New York Council on Adoptable Children, November 18, 1998 Model of the Order of Sovereign Congress, Grade of Great Cross, Congress of the Republic of Guatemala, November 18, 1998 Advocacy Award, New York University Child Study Center, December 1, 1998 Lifetime Achievement Award, Life Directions, December 3, 1998 Humanitarian Award, America's Buffalo Soldiers Re-Enactors Association, February 1999 Rock the Vote Award, MTV, February 19, 1999 Award of Excellence 1998-1999, United States Committee for UNIFEM, March 4, 1999 Shalom Chaver Award for International Leadership (received jointly with the President), Yitzhak Rabin Center for Israel Studies, March 18, 1999 1999 Lifetime Humanitarian Award, Children of Chornobyl Relief Fund, April 19, 1999 Jill and Ken Iscol Lecture Series, Teachers College, Columbia University, April 19, 1999 Certificate of Recognition for outstanding contribution to the welfare of children, Syosset Council of PTAs, April 20, 1999 John F. English Award Public Service Award, Hofstra University, April 20, 1999 Albert Shanker Award, New York State United Teachers, April 22, 1999 Ellis Island Medal of Honor, National Ethnic Coalition of Organizations, May 8, For internal use only - not for public distribution 12 1999 Humanitarian Award, American Foundation for Suicide Prevention, May 11, 1999 Friend of Playboard, PlayBoard of Northern Ireland, May 20, 1999 Arts Advocacy Award, Americans for the Arts, May 24, 1999 Friend of Education Award, National Education Association, July 5, 1999 Henrietta Szold Award, Hadassah, July 27, 1999 1999 W. Averell Harriman Democracy Award, National Democratic Institute for International Affairs, September 23, 1999 Public Leadership Award, National Breast Cancer Coalition, September 28, 1999 Aesculapius Award of Excellence for the Video PSA recorded for the National Colorectal Cancer Roundtable, Health Improvement Institute, October 1999 Honored for her Tireless Efforts on Behalf of Children Everywhere, African Ambassadors' Spouses Association, October 14, 1999 Award of Appreciation, National Federation of Filipino American Associations, October 15-17, 1999 1999 Public Interest Advocate Award, National Association for Public Interest Law, October 29, 1999 Lelia J. Robinson Award, Women's Bar Association of Massachusetts, November 3, 1999 Leadership Award, New York University Global Law School Program, November 20, 1999 Most Distinguished Woman of Vision Award, American Committee of the Weizman Institute of Science, January 26, 2000 Irish American Peace Prize, Irish American Democrats, February 14, 2000 Woman of Distinction Award, Continental Societies Inc., New York Chapter, March 11, 2000 Honored by the Girl Scouts of Suffolk County, March 16, 2000 Honorary Member, National Association of Women Business Owners, New York City Chapter, March 21, 2000 Winning Spirit Award for Commitment, Women's Information Network Against Breast Cancer, March 28, 2000 Village Banking Award, Foundation for International Community Assistance, April 6, 2000 Champion for Children Award, Child Abuse Prevention Services, April 6, 2000 Millennium Special Recognition Award, Brooklyn Democratic Party, April 13, 2000 Honored for commitment to the families of those individuals affected by Autism, The Autism Coalition of the Empire State, June 11, 2000 Oliver Project's Humanitarian Award, Orphan Foundation of America, June 12, 2000 Leadership Award, Hispanic Democrats of Westchester, June 16, 2000 Honorary Carpenter, New York District Council of Carpenters Apprentice and Journey Level Retraining Program, June 22, 2000 Citizen of the Year Award, Temple Adath Yeshurun, June 27, 2000 MEMBERSHIPS AND ASSOCIATIONS: For internal use only - - not for public distribution 13 Member, Arkansas Bar Association Member, Arkansas Trial Lawyers Association Member, Arkansas Women Lawyers Association Member, Pulaski County Bar Association Honorary Life Member, The Honor Society of Phi Kappa Phi Founder and President, Arkansas Advocates for Children and Families, Founder, President and Member of Board of Directors, 1977-84 Chair, Arkansas Rural Health Committee, 1979-80 Chair, Board of Directors, Children's Defense Fund, Washington, D.C., 1986-91, Member, Board of Directors, 1976-92 Chair, Arkansas Education Standards Committee, 1983-84 Yale Law School Executive Committee, New Haven, Connecticut, 1983-88, Treasurer, 1987-88 Southern Governors Association Task Force on Infant Mortality, 1984-85 Member, Commission on Quality Education, Southern Regional Education Board, 1984-92 Honorary Membership, American Association of University Women, since 1984 Honorary Membership, Delta Kappa Gamma Society International, since 1985 Chairman, Honorary Mathcounts, Arkansas Society of Professional Engineers, 1985-86 Member, Youth and America's Future: The William T. Grant Foundation Commission on Work, Family, and Citizenship, 1986-88 Board of Directors, Wal-Mart Stores, Inc., 1986-92 Board of Directors, Child Care Action Campaign, New York, New York 1986-92 Board of Directors, Southern Development Bancorporation, 1986-92 Chair, Board of Directors, New World Foundation, New York, 1987-88, Member Board of Directors, 1983-87 Board of Directors, National Center on Education and the Economy, 1987-92 Co-Chair for Implementation, Commission on Skills of the American Workforce Board of Directors, "I Have a Dream" Foundation, 1988-89 Board of Directors, Arkansas Children's Hospital, 1988-93 Board of Directors, New Futures for Little Rock Youth, 1988-92 Member, HIPPY USA Advisory Board, 1988-92 Board of Directors, Franklin and Eleanor Roosevelt Institute, 1988-93 Charter Member, Business Leadership Council, Wellesley College, 1989-Present Board of Directors, Children's Television Workshop, 1989-92 Board of Directors, TCBY (The Country's Best Yogurt) Enterprises, Inc., 1989-92 Board of Directors, National Alliance of Business Center for Excellence in Education, 1990-91 Board of Directors, Public/Private Ventures, 1990-92 Board of Directors, Lafarge Corporation, 1990-92 Arkansas Business and Education Alliance, 1991-92 President, Board of Directors, Arkansas Single Parent Scholarship Fund Program, 1990-92 Chair, National Board of the Claudia Company 1991-93 Honorary President of the Girl Scouts of America, 1993-Present For internal use only - not for public distribution 14 American Workforce, 1991-92 Member, Visiting Committee, University of Chicago Law School, 1991-92 Alumnae Trustee, Wellesley College, 1992-93 Chair, President's Task Force on National Health Care Reform, January-May 1993 Honorary Chair, President's Committee on the Arts and Humanities, 1993-Present Honorary Member, American News Women's Club, 1994 Honorary Chair, U.S. Delegation, United Nations Fourth World Conference on Women, September 1995 Honorary Chair, President's Interagency Council on Women, 1995-Present Honorary Member, The Pen & Brush, Inc., 1996 Honorary Life Member, Women's Council of the University of Missouri-Kansas City, 1996 Honorary Member, National League of American Pen Women, Inc., 1997 Honorary Chair, White House Millennium Committee to Save America's Treasures, 1997- Present Founding Member, The President's Circle of Habitat for Humanity International, March 10, 1998 For internal use only - not for public distribution 00/11/00 ГАЛ In Shift, Mrs. Clinton Stresses start talking to her." Although much of Mrs. Clinton's work at the White House was the Behind-the-Scenes Influence Iraditional advocacy and speech- making of modern first ladles and of Eleanor Roosevelt. her role model - Mrs. Clinton said that on many By ELISABETH BUMILLER ISSUES she was directly Involved in As Hillary Radham Clinton tries to the business of government. She said, rebut the (avorite attack line of Rep- sand Dan McLagan, the congress. for example, that the Clinton admin- resentative Rick A. Lazio, mar she man's chief spokesman. "The bot- istration program to guarantee free has never held public office and has com line la, she's never lifted a finger immunizations for poor and unin- no record for a Scnate campaign, she for New York and is now trying to sured children, passed In 1993, "was and her husband and their staffs are create an Imaginary record." basically drafted in my office under acgressively trying to reverse the Agency heads, other administra- my supervision." The program was reclusive image that she projected tion officials, Democrate and some a precursor to health care and its after her failure on health care re- Republicans on Capitol Hill general- policy was largely rejected by Con- form. Now Mrs. Clinton says that ly confirm Mrs. Clinton's assertions, gress. DUE the Clinton administration rather than retrearing. as the White but say that her role was kept quiet did get $585 million for vaccines. House maintained. she was in fact ID avoid the kind of vilification she Mrs. Clinton also reaid that her working hard behind the scenes pro- had attracted over her central part staff had a large DATE in the develop posing writing and lobbying for cer- in health care policy, mont of the Corporation for National tain legislation, budget appropria. As Mrs. Clinton put it: "People tions and administration policies. were saying, 'We don't care If you Service. the Clinton administration's Her record, she said, Includes exercise Influence as long as we domestic version of the Peace Corps. work on amajor Clinton administra- don't know about It' In any case, "I hired Shirley Sagawa. who had don child-care Initiative, a hugo fed- she said, "I wasn't Interested in get- been Ted Kennedy's person on ne- crai-state. children's health Insur- ting credit for these things." tional service. and SO basically it was No longer does she consider that ance program, adoption and foster my staff that was Involved in draft. care bills and foreign aid appropria- tactic politically helpful to her. "If Ing that legislation," she said. Eli J. tions for small loans overseas. somebody's going to say, 'Well, she's Segal, the first chief executive of the "The record's there, and whar 1 never done anything." Mrs. Clinton Corporation for National Service and did is sort of soll-ovident I think, bur SRIC. "I'm going to say, 'Well, you the 1992 Clinton campaign chief of know, I WRDE to tell you what I did, If may come as new information to a staff. called the first lady's assertion lor of Deople," Mrs. Clinton said in a and you can make your own Judg- "100 percent correct" ments.' 1 think that's a fair and accu- recent interview, acknowledging the Among her other accomplish- rate way to have somebody evaluate contradiction between the years or ments. Mrs. Clinton said she helped what I could do in the Senate." stressing more traditional first lady to initiate and promote the Chil- Mrs. Clinton described her White duties and/the role she claims now, dren's Health Insurance Program, House Issues staff, which has offices The president joined in this week created by Congress in 1997 to pro- in both the West Wing and the old at a fund-raising dinner for his wile, vide 32-1 billion over five years to Executive Office Bullding, "as part states to Insure children. listing various issues and saying, of the domestic policy operation in "She was a one-woman army in- "She basically had an unprecedented the White House." Although she also side the White House to ger this Icvel of activity in her present posi- has a small staff In the East Wing to done," Mr. LittleGeld of Senator Ken- cion over the last eight years." handle first lady social responsibil- nedy's committee said. He said chat In the Interview, Mrs. Clinton ac- Itles, Mrs. Clinton said that "I real- Mr. Kennedy. the Massachuserts knowledged that she had learned to tacd very soon that, you know, if had Democrat who was the mejor force take a more subtle approach in Dush- some first Indy STAM over here, I behind the DILL enlisted Mrs. Clin- ing her projects because of the wouldn't be able to get things done." ton's help in the spring of 1997 when health care debacle in 1994, a humili- She said that she and her policy the president became "skittlsh" ating defeat for the administration staff had the responsibility for push- that banished her from a public poll- Lng logislation and programs that about the program. Mr. Littlefield said the Senate majority leader, cy role next to her husband. But would benefit children, women and Trent Lott. was threatening that it when sho was asked if, by speaking health care Insues that have con- was a "deal Duster" on the balanced 50 openly. she might allenate voters corned her, she said, for the last 30 disturbed by her deep involvement in years. Several of Mrs. Clinton's staff budget agreement that he and Mr. her husband's administration, she members had the title of assistant to retorted: "Well, that's why you nev- the president and were officially on cr knew about It. the staff of Bruce Reed, the prest- Pressed later about whether her dent's domestic pollcy adviser, but new descriptions of acting B5. in es- generally reported to the first lady. sence, a senior presidential adviser Mrs. Clinton's Democratic aup- went beyond the job of first lady, porters on Capitol Hill echo her Mrs. Clinton laughed out loud and claims. "Her office and ber in partic- said: "I'm|not going to have It any ular were key allies of ours-and the more. And the next first lady doesn't progressives in the Senate who were have to do It." trying TO pursue an agenda in the areas of children, education, health Mr. Lazio's campaign dismissed care and job training," SRID Nick Mrs. Clinton's efforts to establish a Littlefield, the staff director at the legislative history, "If she were run- time to Senator FAward M Kenne- ning in MassachuseTTs, che'd take dy's Health. Education and Labor credit for the Boston Tea Party."! Committee. Re added that that "once 1/2 we discovered that Mrs. Clinton was running a public advocacy organiza- non Inside the White House, it fol- lowed automatically that we would The 11.mL #: 08/11/00 11:09 FAX NATL ECONOMIC COUNCIL 003 Clinton had reached. develop a $21 billion White House Harriet Tubman in upstate New "AC that point we went to Mrs. initiative on child care. Mr. Reed. the York. Clinton and said, 'You've got to get presidential adviser, said that he, (Pushing the administration Into the president to come around on this Mrs. Christon and others at the White expanding Medicare coverage, since thing' Mr. Limiefield said. "And House worked with other agencies of January 1998. to pay for ennual she said, 'Absolutely.' And we very the government to develop the pack- mammograms for Medicare pa- quickly noticed a change. The prest- age of programs, culminating in a tlents age 40 and over. Proviously dent was very much on board." December 1997 moeting with agency Medicare covered mammograms She also said she helped to write heads "that the first lady chaired." every other year. bills on adoption and foster care, and Present at the meeting, Mr. Reed "Procuring $40 million in govern- lobbied for them. said, were Robert E. Rubin, then the ment and for the training of pediatri- AT the end of the 1997 Congression- secretary of the Treasury, and Don- clans at children's hospitals, "I fi- al seseion, Representative Dave na Shalala. the secretary of the De- nally got is into the president's budg- Camp. a conservative Michigan Re- partment of Health and Human Serv- ct," Mrs. Clinton said "And I think I publican who was frantically negoti- Ices. Sa far, Congress has given the 500 it Into the budget for 'SS, If I'm ating to save an adoption bill. got a Clinton administration a small part right Then We bad to make sure chat call in the House cloakroom from of what it requested. It stayed in the budget." Mrs. Clinton. She also took credit for helping to David S. Wetner, the chief execu- "It was 9:30 or 10 at night," Mr. tive of Boston Children's Hospital Camp recalled. "I thought only Con- and a leader of the hospital lobbying gressional night owls did that. I was group that worked with Mrs. Clinton surprised. You know, you're working Expansion of to get the money, said that "there wearity on these things, and you're were many people Involved, but with- worrying whether this IS doing any Medicare to out her Initial championing we would good." Mrs. Clinton gave bim a DED have been simply another voice in talk. Mr. Camp said, and told him the the wilderness." He added mat "she bill was worth it Today, although preserving Edith really helped our group of institu- Mr. Camp is enthusiastically Sup- tions strategically. and she advised porting Representative Rick A. La- Wharton's home. us to who the key legislators were zia, Mra. Clinton's apponent in the that we needed to connect with." Senate race in New York, he admits In the interview this month, Mrs. that the first lady's intervention was Clinton also said that after the pain- procure $140 million annually In the important "I want to be honest," he ful health care defeat, she learned foreign aid budget for micro-credit, said. "Ir was helpful to me." more subtle approaches B dealing or small-enterprise loans, to help The bill. an administration priority with Congress poor women around the world. intended to speed up the adoption of "It's important that you get total "What we did at her behest WAS to children in foster care, had been congressional Duy-in from the very negodato B micro-enterprise Inida- heavily promoted by Mrs. Clincon on beginning." she said, "and not just tive with Congress," said J. Brian Capitol HIll. Four days after her call, lip service about the process." She Atwand, who was the administrator it passed the House and Sonate and explained: "We thought we were do- of the United States Agency for In- was soon signed into law by the pres- Ing what the leadership wanted us to ternational Development at the time, do when It came to health care. Bur ident. Almost immediately. Mrs. 1997. when Mrs. Clinton announced Clinton and her White House staff we assumed too much. We abould the initiacive in a speech on Capitol have had them do much more of the began working with the Department of Health and Human Services on a Hill. "The Congress was very Inter- involved work. They basically said, new, related bill to provide more ested in it, but I think she clearly was 'We can't figure out how to do this a catalyst for doing as much." ourselves. so you go do It." And we government help to 18-year-olds who loave foster care because of their Mr. Rubin said she also sparked didn't understand that at that mo age One version of that bill was Incerest In micro-credit programs ment we should have said: 'Well, no, virtually written in Mrs. Clinton's among treasury officials. "Il Isn't that's not the way IT'S going to work that she came out of the White House We'll help you do what you want to office. according to Representative Benjamin L. Cardin of Maryland. the and said 'Do this, da char,' said Mr. do. you know." even If K was our Rubin. But he said that after Mrs. Idea." Democrat who sponsored It Clinton saw a successful bank for On the subsequent adoption and "This was the first Lady's priority, poor women in India. she spoke to foster care Dills. Mrs. Clinton said: and she developed the administra- tion's legislation." Mr. Cardin said. him about importing the methods to "You bad to go sround planting Ideas "And pretty much what was passed this country. with people. You had to go around by Congress was what the adminis- "I don't think people were un- Bort of eliciting Interest and then tration proposed." aware of mlero-credit," he said. saying. 'What a good Idea. We might Mrs. Clinton's role, however, is dis- "But she really brought the Issue to be inscrested." puted by Republicans, who say they life. and gave It energy. And she did She added "We always tried to knew nothing about it. "I Wrote the it by persuading everybody else what create the opportunity for It TO be bill," said Representative Nancy L she had scen." their idea their legislation, their Johnson of Connecticut, the Republi- These are other Initiatives that name on iL We'd push IL we'd help can sponsor who introduced her own Mrs. Clinton Ilats as accomplish- draft It, we'd lobby it, I'd do what I needed to do. But IT, needed to be a version in the House Representative ments: Tom DeLay of Texas, a foster parent 9"Save America's Treasures," real partnership in order to be suc and the aggressive anti-Clinton which has raised $100 to $200 million cessiul." House majority whip who pushed the in public and private money to help bill, said that If Mrs. Clinton was preserve 593 designated Involved, "I never Saw it" ures," among them the homes at MAKE SUMMER DREAMS COME TRUE: She said she oversaw and helped Edith Wharton in Massachusetts and SUPPORT THE FRESH AIR FUND 2/2 08/11/00 11:09 FAX NATL ECONOMIC COUNCIL 004 Newsday.com - Friday - - Key Player In Labor Laws Training bills helped by Hillary Page 1 of 7 Yewsday com ADVERTISEMENT NEWS NEWS SHOP 08/11/2000 - - Friday - Page A 4 BUSINESS Key Player In INSURE Labor Laws OPINION Training bills helped by Hillary GREAT 10:41 stuil ARCHIVES by Elizabeth Moore stil INDIX Staff Writer U.am SEARCH Drifting through Farmingdale High School, Jackie Rindos knew she liked art class and psychology, felt Last 7 Days misunderstood by her family and had seen how cruel LI A to Z people can be. She did not know these were job skills. Fun Book 2000 Not until an art teacher nudged Rindos to take a taste of the Obituaries real world in Patricia Graham's "internship class." While LI History some kids headed for emergency rooms and others for offices, Graham found Rindos a placement as an an therapist four days a week at the Helen Kaplan How to Subscribe Intermediate Care Facility for mentally retarded adults in Plainview. Once she got past her fear and discomfort with How to Advertise PROGRAMS the residents and came to know them as people, the work About Us FUTURE CORPS she was doing began to amaze her. Contact Us NEWSDAY IN EDUCATION "Ir's like finding the true meaning of what life is," said NAMES or NEW YORK Rindos, 18, who fit in so well she was hired back for the LONE (SLANDER summer and plans to start work in September on a degree OF THE CENTURY in art therapy from C.W. Post in Brookville. SUMMER CAMP APPEAL Farmingdale's internship class is one of dozens of programs around New York State funded under a federal law first drafted and promoted a decade ago under the leadership of Hillary Rodham Clinton. Then the first lady of Arkansas, Yale-educated partner in a Little Rock law firm and a prominent education reform advocate, Clinton had been hired by the bipartisan Commission on the Skills of the American Workforce to head the effort to implement dramatic changes in the way the United States trained its work force for a rapidly evolving global economy. For a year or so. Clinton and her colleagues crisscrossed the country meeting with executives, educators and Democratic and Republican governors, testifying before http://www.newsday.com/coverage/current/news/friday/nd7650.hm 8/11/00 08/11/00 11:10 FAX NATL ECONOMIC COUNCIL 1 006 Newsday.com Friday - Key Player In Labor Laws Training bills helped by Hillary Page 3 of 7 Lazio's campaign has hammered away at those themes. "In fact, her only experience in drafting legislation ended in disaster," Lazio wrote in an Aug. 7 fund-raising letter, referring to health care. But Nick Littlefield, Kennedy's longtime chief of staff on the Labor and Human Resources Committee who worked closely with Clinton and her policy staff, said the first lady had played an "integral role" in shaping the job-training laws. as well as in every piece of progressive Clinton-era legislation on health, children's issues and national service. "She was facilitating all this legislation, consulting and advising, but the point was to have the credit go to the legislators and to the president." Littlefield said. "They all got the credit, but she did the work." Like the health-care effort, the America's Choice report was an expansive undertaking, involving more than 2,000 interviews at more than 550 U.S. companies. Climon went forth across the nation calling for a complete retooling of the way Americans are prepared for the job market, including doing away with high school diplomas in favor of an educational model closer to that of some European countries. Participants give her mixed reviews, but the leading industry, government and education figures who called on her saw nothing foolhardy about the scale of their enterprise. "This is the first time that a comprehensive national system like this has been attempted." said James Houghton, a former chief executive officer of Corning Inc., of the National Skills Standards Board be now heads, in a statement last year. The Commission on the Skills of the American Workforce was launched in Rochester in 1990 by the National Center on Education and the Economy, a Carnegie Corporation spin-off where then New York Gov. Mario Cuomo served as honorary chairman and Hillary Clinton as a trustee on a board that also included David Rockefeller Jr., Apple Computer chairman John Sculley and Easuman Kodak CEO Kay Whitmore. Headed by consultant Ira Magaziner, who would later lead the Clinton health care effort, the commission was co- chaired by two former labor secretanes, Republican Bill Brock of the Reagan administration and Carter-era Democrat Ray Marshall. http://www.newsday.con/coverage/current/news/friday/nd7650.hm 8/11/00 08/11/00 11:10 FAX NATL ECONOMIC COUNCIL 5. 007 Newsday.com - Friday - Key Player In Labor Laws Training bills helped by Hillary Page 4 of 7 Their central concern was the slipping economic position of U.S. industry relative to other countries and the weak skills of its work force. "Many of our companies were beginning to beheve they could not compete with the Japanese and the Germans," said Marshall, who had served on the board that rescued the Chrysler Corp. from insolvency and had traveled as a trustee of the Carnegie Corporation to those countries learning humbling lessons about how much better they prepared both school kids and mid-career workers for success at work. "Our schools were still turning out the kind of people we needed in the 1950s and 1960s," when rote, repetitive assembly line tasks were the norm in industry, Marshall said. At a time when American workplaces were demanding increasing sophistication and adaptability, U.S. students not bound for college were getting few job skills and little or no guidance or employment services. The commission urged a series of changes in schools and government: Establish a new Certificate of Initial Mastery, to be carned by age 16. Students could then choose to work, to gain occupational training or to prepare for college. A comprehensive system of technical and professional certificates should be created for students and adult workers. Employers should be called on to invest at least 1 percent of payrolls in training and retraining. And a network of training boards should be created to organize and oversee the new offerings. "We were suggesting major changes," acknowledged Marc Tucker, president of the national center. And while the commission's heavyweight membership was a reflection of broad sentiment that such changes were warranted, "Nothing sells itself. It's an enormous competitive bazaar of ideas out there," Tucker said. Clinton started out as one of the more active but less visible advocates for the America's Choice report, first unveiled at a June, 1990, ceremony. The Clintons then were bright lights in a small circle of governors who had become opinion leaders on education reform, the hot governing topic of the day. A stream of staff jobs and seats on corporate and nonprofit boards, commissions, and studies over the years, as well as chairmanship of the Children's Defense Fund, had kept Hillary Clinton involved in domestic policy debates and in regular touch with a wide network of public officials, business, union and community leaders and academics. http://www.newsday.com/coverage/current/news/fiday/nd7650.hump 8/11/00 08/11/00 11:11 FAX NATL ECONOMIC COUNCIL 1 008 Newsday.com - Friday - Key Player In Labor Laws Training bills helped by Hillary Page 5 of 7 Her kitchen at the Arkansas governor's mansion has been described as a kind of down-home think tank, where friends from all over the country munched chocolate chip cookies and kicked ideas around late into the night. By that time she had waged five political campaigns with her husband and run his education agenda, including a proposal to raise teaching standards in exchange for better teacher pay. In those days, "there was an incredibly bipartisan, friendly, collegial atmosphere among the governors, between the partics," Clinton said, recalling warm relations with President George Bush and Barbara Busb. "We used to get good ideas from each other." It was possible to have "good, vigorous debate" strictly on the merits of a proposal, Clinton said. "I was there to work." It was "a very smart move to bring her in here," because of her close contacts with governors, said Brock, a former Republican National Committee chairman, calling Chnton "obviously intelligent and knowledgeable and competent to deal with this subject." Clinton advised the report's framers to bring in political sponsors and devise a media strategy well before they released it if they wanted to make a splash, Marshall recalled: "Politicians. not read the report, but they are vigorous readers of the press and watchers of television," Marshall said. She and Magaziner condensed the report into an easy-to- read five-page article with a dramatic warning: "What we are facing is an economic cliff-and the frontline working people of America are about to fall off." They began a schedule of meetings with state agencies, unions, the Bush administration, and a dozen Republican and Democratic governors. "She could go imo any audience, whether local business leaders or school community or the teachers or the parents or the governor's office or [Education Secretary] Lamar Alexander's office and basically relate, and gez them excited," Magaziner said. Clinton meanwhile had worked with Kennedy's staff to draft a bill based on the report and had lined up bipartisan sponsorship in both houses that included Sea. Mark Hatfield (R-Ore.) and Reps. Richard Gephart (D-Mo.) and Ralph Regula (R-Ohio). Two days after the bill was filed in the Senate, on Oct. 3, 1991, Bill Clinton declared his candidacy for president, and Hillary Clinton withdrew from the project. The bill went to the back burner for the duration of the campaign. But her husband made those ideas a "mantra" in the http://www.newsday.com/coverage/current/news/friday/nd7650hm 8/11/00 08/11/00 11:11 FAX NATL ECONOMIC COUNCIL 010 Newsday.com - Friday - Kcy Player In Labor Laws Training bills helped by Hillary Page 9 of 7 herself does not seem to have wasted much energy grading her own work. "When you put out a report like that, you know that you're going to set a sort of a benchmark, but the political process will only gel you a certain way there," she said. "That's all that can realistically be accomplished." Rindos, the Farmingdale high school graduate, says she is happy with the results she had an opportunity to sample. "I don't really know her." she said of Clinton, but "I think they should make every student take that class." Copyright © Newsday, Inc. Produced by Newsday Electronic Publishing. 8/11/00 Clinton Presidential Records Digital Records Marker This is not a presidential record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff. This marker identifies the place of a tabbed divider. Given our digitization capabilities, we are sometimes unable to adequately scan such dividers. The title from the original document is indicated below. HRC - FY01 Wins Divider Title: Reauthorization of the Violence Against Women Act (VAWA): The Violence Against Women Act, enacted in 1994, established new Federal criminal provisions and important grant programs that have improved the criminal justice system's response to violence against women, and directed critical services to victims. Reauthorization this year was critical because VAWA's essential grant programs expired on September 30. The recently-passed reauthorization will, among other things, maintain and increase support for key VAWA grants programs; provide important protections for battered immigrant women; provide additional assistance to Indian tribes; reauthorize the domestic violence hotline, and help state courts improve interstate enforcement of protection orders. Last week, Congress approved VAWA as part of the Trafficking Victims Protection Act, which will be signed into law by the President shortly. HRC Role: Earlier this year, the First Lady's domestic policy staff took over the responsibility within the White House for efforts to reauthorize VAWA, and worked to increase the visibility of the issue. At a White House event on June 12, the First Lady announced key law enforcement support for reauthorization and joined a bipartisan group of lawmakers to urge Congress to reauthorize VAWA. In June and again in October, Mrs. Clinton used her weekly column to highlight the success of VAWA and to call for reauthorization. Her staff continued to work to elevate the issue by ensuring that reauthorization was included among the Administration priorities and pushing for a Presidential event underscoring the importance of reauthorizing VAWA. Mrs. Clinton has promoted VAWA around the world as a model statute to deal with this serious problem. Working to Ban the Practice of Trafficking Women and Children. Last week the Congress passed H.R. 3244, the "Victims of Trafficking and Violence Prevention Act of 2000" ("the Act"). This landmark legislation provides important new tools and resources to combat the worldwide scourge of trafficking in human beings and provides vital assistance to the victims of such trafficking. Trafficking in women and girls, a modern day form of slavery, has become one of the fastest growing criminal enterprises in the world. It is estimated that 50,000 women and children are trafficked [each year] to the US, from all over the world under false pretenses and placed in bondage. HRC's Role: Responding to the pleas of women she met from Ukraine to Thailand, Mrs. Clinton has fought for congressional and international actions to combat the trafficking of women and girls, and her staff led an interagency effort, working especially closely with the State Department and the National Security Council to develop and execute the legislative strategies that eventually led to the passage of this bill. Vital Voices representative spoke to Members of Congress about the need for the legislation. Breast and Cervical Cancer Treatment Act: This legislation provides a new Medicaid treatment option for low-income, uninsured women diagnosed with breast or cervical cancer through CDC's Breast and Cervical Cancer screening program. Last week, Congress cleared the legislation for the President. HRC role: The First Lady worked within the Administration to build support for the proposal and successfully argued for inclusion of $220 million for the initiative in the President's FY 2001 budget. (There was some resistance because it carved out within Medicaid special treatment for the two diseases.) Since inclusion in the budget, she and her staff pushed hard for Congressional approval, ensuring that the legislation was included among White House legislative priorities and was raised by the President in his dealings with Republican Congressional leaders. They also worked closely with the National Breast Cancer Coalition. In July, Mrs. Clinton received an award from the group for her leadership. Day Care Health and Safety Act. On October 17, 2000, the President signed the Children's Health Act which included the Day Care Health and Safety Act. The Children's Day Care Health and Safety Act, a component of the Children's Health Act, provides grants to states to improve the safety and health of child care by: training and educating child care providers on preventing injuries and illnesses; improving state health and safety standards; improving enforcement of standards, including increased unannounced inspections; renovating child care facilities to meet health and safety standards; enhancing child care providers' ability to serve children with disabilities; and conducting criminal background checks on child care providers. HRC role: The President's Child Care initiative, spearheaded by the First Lady and outlined in his 1998 State of the Union, included investments to help make child care more affordable for working parents, improve its quality, and strengthen enforcement of state health and safety standards. The First Lady has long advocated for improved health and safety of child care centers through her work on the White House Conference on Child Care, the Child Care initiative, and the Healthy Child Care America campaign. The Day Care Health and Safety Act supports the Administration's Child Care initiative by providing greater assurance to the millions of parents who rely on child care providers that their children are receiving child care that protects their safety and health. Intercountry Adoption Act: On October 6, 2000, President Clinton signed H.R. 2909, The Intercountry Adoption Act of 2000. The Hague Convention was negotiated by the US and sixty- five other countries in response to abuses in the intercountry adoption process, including illegal child trafficking. The Convention acts as a global legal framework designed to protect adoptive children and their families, and to streamline the international adoption process. The Convention was signed by the United States on March 31, 1994. The Intercountry Adoption Act ratifies the convention and provides for the implementation of the agreement. HRC role: The First Lady is the Administration's most vocal advocate for adoption. She has long been concerned about ratifying the Hague Convention and ensuring that we implement it properly in order to put in place the needed protections for internationally adopted children, as well as their birth parents and adoptive parents. Last year alone, more than 16,000 children were adopted internationally. The First Lady has been concerned that with this rising number, we needed to ensure that we had protections in place. The Intercountry Adoption Act provides for the necessary protections. Expanding Access to Credit for Economic Growth. On October 17, the President signed H.R. 1143, the "Microenterprise for Self-Reliance and International Anti-Corruption Act of 2000." The primary purpose of this legislation is to authorize continued and expanded efforts to provide assistance to the world's poorest entrepreneurs many of whom are women. Microenterprise programs help self-employed entrepreneurs obtain loans for small business enterprises to begin the process of growing out of poverty. Experience has shown that these small loans are repaid and, in the process, these small-scale enterprises generate income and jobs for poor families. HRC's Role: For the last 15 years Mrs. Clinton has been devoted to the development of microenterprise programs as an effective tool to fight poverty. She was on the front lines in Arkansas developing and supporting some of the first microenterprise programs in the United States. At the UN Fourth World Conference for Women in Beijing, it was one of our country's key commitments. She spoke at Beijing +5 on the topic and keynoted the microenterprise summit. As First Lady, Mrs. Clinton has traveled around the world promoting the good work/of microcredit programs and encouraging greater funding through USAID. Her staff has worked closely with the nonprofit microenterprise community represented by the Microenterprise Coalition to develop and execute legislative proposals and strategies for this bill. Support for the National Endowment for the Arts. President Clinton proposed to expand resources for the National Endowment for the Arts to provide support for the important cultural, educational and artistic programs for communities across America. Working together, the President and the Congress were able to increase funding for the NEA to $105 million, a $7 million boost over last year's funding level and the first significant increase in the six years since the Republicans took control of the Congress. HRC's Role: Over the course of this Administration, Mrs. Clinton has been a staunch supporter of the NEA. Her office has primary responsibility for the arts and has worked within the White House and with the advocacy community in support of greater resources. Clinton Presidential Records Digital Records Marker This is not a presidential record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff. This marker identifies the place of a tabbed divider. Given our digitization capabilities, we are sometimes unable to adequately scan such dividers. The title from the original document is indicated below. Foreign Policy & Ethnic Divider Title: FIRST LADY HILLARY RODHAM CLINTON WORKING TO STRENGTHEN DEMOCRACY IN UKRAINE "It was Taras Shevchenko who wrote 'In your house you will find then, truth and strength and freedom.' In your home of Ukraine, we have found them, those citizens who work in the name of truth, those who push forward with strength, and those who fought for and sometimes died for freedom [Y]ou found the best shield against oppression, you started down the road to democracy. "But the journey is far from over but if we, in Ukraine and in the United States, want democracy and freedom to thrive, then we must build a civil society where democratic values live in our hearts and minds, where people stand up for what is right, and where the rule of law, not the rule of crime and corruption, prevails I want you to know that the American people will stand with you, and as you undergo the hardships of this historic transition that you are accomplishing here in your country. "We know that the road you have chosen is a difficult one, but it is the right road and we will walk that road with you, now into the next century and millennium. Because America has faith and confidence in the people of Ukraine, and as we have learned from the many contributions of Ukrainian-Americans, we have seen that you will be successful in creating a democratic, prosperous, stable Ukraine. 'God Bless America,' and 'Slava Ukraini. HRC Remarks at the Monument to the Victims of Communist Repression Lviv, Ukraine, 11/17/97 First Lady Hillary Rodham Clinton visited Ukraine twice as goodwill ambassador. There she celebrated Ukrainian and American friendship and our country's commitment to help Ukraine build its democracy and market economy. On her visits, she also advocated for better health care, especially for children, and for women's progress, and praised programs that were working towards those goals. Mrs. Clinton also commemorated the memory of the Jews and others who perished in the Holocaust and lauded efforts to rebuild Ukraine's Jewish community. Advancing Ukraine's Democracy In 1997, Mrs. Clinton delivered a major address at the historic Ivan Franko Opera and Ballet Theater in Lviv in which she praised Ukraine's movement towards a strong democracy and market economy and talked about the importance of building civil society. She said: "When I first came to Ukraine, it was with my husband in 1995, and the sun of freedom was rising in the sky. In the time I have been here, I have seen how much farther the sun has traveled. In only six years, you have done much to sweep away the oppressive structures of communism. You developed a constitution and held free and fair elections - which resulted in the peaceful transfer of power, the first ever in NIS. Now the challenge is to build upon this architecture of freedom." [HRC Remarks, 11/18/97]. Mrs. Clinton also delivered moving remarks at Memorial Honoring the Victims of Communist Repression, where thousands of citizens of Lviv came to hear her speak. Promoting Ukrainian Women's Progress and Fighting the Scourge of Trafficking. Responding to the pleas of women she met from Ukraine, Mrs. Clinton has fought for national and international actions to combat the trafficking of women and girls. She worked hard for a bilateral agreement between the U.S. and Ukraine, which was announced by the President and First Lady at the White House in March 1998. This initiative directed the U.S. Government to work with the Ukrainian government to develop a comprehensive strategy to fight trafficking with a hope that it will become a model for anti-trafficking efforts around the globe. Representing the U.S., Mrs. Clinton also announced additional U.S. Government assistance to combat trafficking at the Organization for Security and Co-operation in Europe (OSCE) Conference in Turkey in November 1999. When Mrs. Clinton delivered remarks at the Opera House in Lviv, she also spoke out against the trafficking in women and girls, a modern day form of slavery, which has become one of the fastest growing criminal enterprises against women and humanity in the world. Mrs. Clinton announced a major new U.S.-U.N. partnership for an information campaign to reach women who may be in danger, and to inform law enforcement and consular officers, and international organizations so they can be on the look out for, and ultimately put a stop to these criminal operations. This past June, Mrs. Clinton's Chief of Staff represented the First Lady at a conference in Ukraine, sponsored by the U.S. and Ukrainian governments, where she delivered a keynote address on law enforcement efforts to combat trafficking. To coincide with this conference, a major Ukrainian daily newspaper carried an interview with Mrs. Clinton. Working to Improve Health Care for Ukraine's Children Mrs. Clinton has been particularly active on issues relating to health care in Ukraine. In 1995, she visited the Left Bank Center for Maternal and Child Health Care to underscore the importance of prenatal care programs in Ukraine. She also helped inaugurate the Ukrainian Nurses Association and announced several public-private partnerships and new donations to support health care in Ukraine. [AP, 5/11/95] In 1997, Mrs. Clinton visited the Lviv Oblast Clinical Hospital where she presented humanitarian aid shipments to the hospital's neo-natal center and another children's hospital in Lviv, commended the hospitals for their partnerships with U.S. organizations and held a discussion regarding children's emergency care. Working for Humanitarian Relief in the Aftermath of Chernobyl Mrs. Clinton has also worked hard to help children who have been affected by the tragic Chernobyl nuclear power plant explosion. Mrs. Clinton has worked closely with the Children of Chornobyl Relief Fund, a humanitarian fund to protect and save the lives of children who were affected by the aftermath of the nuclear explosion, and personally contributed to the organization through proceeds from her book, It Takes a Village. In April 1996, Mrs. Clinton held a White House event to commemorate the 10th anniversary of the Chernobyl tragedy. At the event, which included participation from a child recovering from the health effects of Chernobyl, as well as high government officials, she announced an additional commitment of U.S. support. Mrs. Clinton has been honored by the Children of Chornobyl Relief Fund for her work. Honoring the Past and Celebrating the Rebirth of the Jewish Community in Ukraine In 1995, Mrs. Clinton visited Babi Yar with the President where she left flowers at the Menorah and laid a wreath in memory of the more than 30,000 Kyiv Jews and others were killed by the Nazis over the course of two days in September 1941. When she returned to Ukraine in 1997, she visited the Gilad Synagogue "the city's only Jewish house of worship to survive the Nazi occupation during World War II. After being vandalized by the German invaders and used as a warehouse by the Soviets, the synagogue was returned to the Jewish Community in 1989." [AP, 5/12/95; AP, 11/17/97] Celebrating Ukraine's Heritage and Meeting Poland's Leaders During Mrs. Clinton's trips to Ukraine, she met with Ukraine's government leaders and held discussions with women's advocates in Ukraine with whom she discussed strategies for improving conditions. Mrs. Clinton laid flowers at Shevchencko Monument, visited the National Museum, and St. George's Cathedral. After her 1997 trip to Ukraine, Mrs. Clinton held a briefing in Washington for members of the Ukrainian American community and other ethnic representatives. The First Lady arranged for the Kyiv Chamber Choir to perform at the White House at Christmas in 1997, and she is honorary chair of the current exhibition at the Brooklyn Museum of the Art called "Gold of the Nomads: Scytheian Treasures from Ancient Ukraine." HILLARY RODHAM CLINTON: WORKING TO STRENGTHEN DEMOCRACY AROUND THE WORLD As First Lady, Hillary Rodham Clinton has spoken out on the importance of U.S. global leadership, human rights and women's full participation in advancing their democracies and free-market economies. Promoting Women's Progress. To fulfill America's foreign policy objectives in advancing democracy and fostering free market economies requires the full participation of women. In her groundbreaking and widely praised address to the United Nations Fourth World Conference on Women in Beijing, in 1995, Mrs. Clinton emphatically stated that "If there is one message that echoes forth from this conference, let it be that human rights are women's rights And women's rights are human rights, once and for all." Mrs. Clinton worked to create and serves as the honorary chair of the President's Interagency Council on Women which was established to follow up on achieving the goals of the conference, such as microenterprise development, combatting violence against women, promoting women's political participation. Mrs. Clinton has been a world- spokesperson on these issues. She keynoted the UN Population Forum at the Hague, the UN Social Development Conference in Copenhagen, the WHO Conference in Geneva, the World Bank's Safe Motherhood Conference, the Inter-American Development Bank Conference on Violence Against Women, and other major global convenings. Advancing the Vital Voices Democracy Initiative. Mrs. Clinton worked to create the Vital Voices Democracy Initiative, an on-going global initiative and a public-private partnership which highlights and supports the critical role that women play in developing full participatory democracies, increasing economic prosperity and strengthening political systems. Vital Voices has been implemented through the active support of the First Lady to give women the skills, tools and resources they need to empower themselves, their countries and their communities. She has participated in conferences and convenings in Austria, Uruguay, Northern Ireland, Italy, Turkey, Iceland, Mexico, Bulgaria, Haiti, and the Caribbean, Tunisia, the Philippines, Kazakhstan, Russia, Ukraine, India, Pakistan, Bulgaria and Uganda. Working to Improve World Health Working to Improve Women's Health and Access to Family Planning. Mrs. Clinton has fought for increased investments to improve women's health, including funding for family planning. She has also been instrumental in leading the Administration's efforts to raise awareness of and increase funding for HIV-AIDS prevention, especially in Africa. Leading the Fight Against Deadly Diseases. Mrs. Clinton held the first high-level, strategic HIV/AIDS meeting at the White House with Administration officials, and foundation and business leaders to explore strategies to better address the AIDS pandemic, which eventually led to major Administration initiatives in this area. She also convened an Administration-wide meeting on Malaria, which led to a new initiative announced during President's trip to Africa. Mrs. Clinton convened major international funders of TB treatment to promote better collaboration and to target urgent global problems. Championing Human Rights Working to Combat Trafficking of Women and Children. Trafficking in women and girls, a modern day form of slavery, has become one of the fastest growing criminal enterprises in the world. Responding to the pleas of women she met from Ukraine to Thailand, Mrs. Clinton has 10/29/00 12:36 PM FOR BACKGROUND PURPOSES fought for congressional and international actions to combat the trafficking of women and girls. Historic anti-trafficking legislation cleared the Congress in early October and various bilateral and multilateral international agreements have also been achieved, including an announcement of U.S. Government aid to combat trafficking in the OSCE region. Speaking Out Against Human Rights Abuses. Mrs. Clinton has often spoken for many of the world's voiceless and disempowered, raising issues such as human rights abuses against women and children to a level of international prominence. She supported successful efforts to ban female genital mutilation in Senegal and has supported efforts elsewhere, describing FGM as both a human rights and health issue. She has met with Rwandan genocide victims and supported the work of the International Committee on War Crimes. She spoke with countless representatives of victims of human rights violations from Algeria's Mothers of the Disappeared to the Grandmothers of Plaza de Mayo in Argentina. Mrs. Clinton worked on behalf of the Kosovar refugees, helped to raise humanitarian assistance from the non-profit sector and private entities. She visited with the refugees in the camps in Macedonia and greeted those who arrived in the U.S. Supporting Children's Rights. Mrs. Clinton delivered major addresses on international children's rights in the U.S. and around the world and has fought for the United Nations Convention on the Rights of the Child and for related Protocols on Children in Armed Conflict and on the Sale of Children. Mrs. Clinton has also led Administration's support for girl's education initiatives because "we know that when we educate a girl, we improve the health of women and families. We know that a woman who has had even a single year of education has children that have a better chance of living. We know that as the years of schooling increase, the chances of the child living, and living well, increase as well. When we educate a girl, we decrease poverty by helping women support themselves and their families." [HRC Remarks at USAID Girls Education Conference, 5/7/98] Promoting Religious Tolerance and Minority Rights. Mrs. Clinton has spoken out for religious tolerance around the globe. She has visited historic Jewish sites in Ukraine, Uzbekistan, China, Poland, Egypt and the Czech Republic and has highlighted the plight of Roma in Central Europe. Mrs. Clinton was also instrumental in urging U.S. action to help bring some measure of justice to Holocaust victims and their families. Promoting Economic Development. Mrs. Clinton has long recognized and promoted microcredit as an effective means of unleashing the economic potential of impoverished and developing communities and as a force to economically empower women. She has promoted microcredit worldwide and has shared best practices with women from India to Nicaragua. Mrs. Clinton's work has been the driving force behind the international microcredit bill that recently passed the Congress and will provide $155 million each for the next two fiscal years to support international microcredit programs. Building Civil Society. Mrs. Clinton has often noted that democracies depend on strong free economies, on governments that protect and enforce the rule of law, and on the strength of civil society. In the speech to the World Economic Forum in Davis, Switzerland, she said "it behooves all of us, no matter what our perspective or experience, to think hard about how we create conditions in which the economy, governments, and the civil society all flourish." 10/29/00 12:36 PM FOR BACKGROUND PURPOSES HILLARY RODHAM CLINTON: WORKING TO STRENGTHEN DEMOCRACY AROUND THE WORLD "Now, certainly, the world in which we live is very different. We are living in what is called, for want of a better description, the post-Cold War era. That means that we know where we 've been, and we sort of know where we are, but we're not sure at all where we're going. Because the world around us has changed so rapidly that we barely have time to catch our breath. And in time of rapid change, it is understandable that some are inclined to draw inward and pull back from the obligations, to catch their breaths, thinking that maybe there isn't much that can be accomplished and that we should just tend to our business here at home. "But of course, in today's world, that's not even really an option. Every day we see how profoundly interconnected we are in this new era of globalization. Whether it is the international economic crisis or the extraordinary boom in worldwide communications or the threat of infectious diseases or terrorism. We have to acknowledge that, in many ways, our lives and even our destinies are intertwined "I'm fully confident that when the history of the past 50 years is written, we will not only point to the Cold War and its ending, we will not only recognize that the values of America have been given an opportunity unlike any opportunity in human history to flourish, but we will also recognize that our nation has a great deal at stake in working with people all around the world who wish to build a better, more peaceful, more stable, economically prosperous future. [HRC Remarks at USAID Atrium Dedication Ceremony, Washington, D.C., 3/16/99] Mrs. Clinton has spoken out in the United States and around the world on the importance of U.S. engagement to build civil society, strengthen democracy, and empower women in all nations. Attached are highlights of some of the events she held in the last few years. Supporting efforts to ban female genital mutilation (Senegal, Africa, 4/98) Promoting civic participation - - the work of democracy (Palermo, Sicily, 6/99) Meeting with the Ecumenical Patriarch Bartholomew and other religious leaders on the issue of religious tolerance (Istanbul, Turkey, 3/96) Working to combat trafficking of women and children with OSCE (Istanbul, Turkey, 11/99) Speaking for the essential rights and responsibilities of women in emerging democracies - promoting women as "Vital Voices" (Austria, 11/97) Focusing on the importance of early childhood education (Lisbon, Portugal, 11/97) Working to Bring Justice to Holocaust Survivors and their Heirs "We all have much to do to bring this tragic chapter of European history to a just end. And we owe it to the victims, not only of the Holocaust, but we also owe it to ourselves, to complete that task. The spotlight of history, whether it is on race and slavery in the United States, or apartheid in South Africa, or the Holocaust here in Europe, can be harsh, but it is only through facing that history that we can strengthen our commitment to democratic ideals and to keep working together to fulfill those ideals. And we shall learn the lessons of the past, because we ignore them at our peril.' Address by First Lady Hillary Rodham Clinton University of Zurich, 1/31/98 First Lady Hillary Rodham Clinton was instrumental in ensuring that the Administration worked to bring some measure of justice to Holocaust survivors and their families. When Edgar Bronfman, Sr. ran into problems in 1996 in his efforts to see that Swiss banks returned funds to Holocaust victims, he asked the First Lady for help. Mrs. Clinton responded immediately, and the White House got involved. The President and his Administration have achieved the following steps: Established a Presidential Commission headed by Edgar Bronfman to research Holocaust assets that came under the control of the US government during and after WWII. Launched two comprehensive studies on Nazi gold and the role of neutral countries in supporting Nazi Germany. The US joined with other nations to establish a fund totaling $60 million to aid needy survivors. Secured a $1.25 billion settlement in the case against the Swiss banks responsible for withholding the savings of Holocaust victims. Created an International Commission for Holocaust-Era Insurance Claims and some of Europe's largest insurance companies have agreed to establish a fund to deliver on policies they sold to victims and refused to pay to heirs. Convened a 1998 conference where 44 nations agreed by consensus on principles to guide the identification and return to rightful owners of Nazi-looted art. Brokered a $5.1 billion agreement for slave and forced laborers and others injured by German companies during WWII. This agreement was reached as a result of the direct intervention of President Clinton and Chancellor Schroeder. FIRST LADY HILLARY RODHAM CLINTON A COMMITMENT TO BUILDING DEMOCRACY IN THE CZECH REPUBLIC Mrs. Clinton visited the Czech Republic twice, once July 3-6, 1996 and a second time on October 12-13, 1998. The focus of Mrs. Clinton's visits to the Czech Republic was to underscore U.S. support of the new democracy and to support Czech efforts to build a strong civil society. Mrs. Clinton was accompanied by President Vaclav Havel and Secretary Albright through much of her first trip. She delivered a major address at Radio Free Europe/RadioLiberty headquarters where she said: "Last night, it was a beautiful evening in Prague, and I walked across the Charles Bridge [with President Havel]. It was filled with young people, talking, laughing, listening to music But I was also reminded of the young men and women of earlier generations who lost years of their productive lives in prison or exile to make sacrifices for the values we celebrate today. And I thought too of all the young people who fought and died for the freedom to form their own ideas, speak their own words, make their own decisions and dream their own dreams [I]t is our duty, having struggled so long to arrive at this moment of opportunity, to pass on to them a clear understanding of the values that will guide their choices as well as the decisions societies make In President Havel's eloquent words: "we are not accountable solely to our party, our voters, our lobbies and our states, but in fact to the entire human race, including those who come after us, and that the decision on the worth of our deeds will ultimately be made beyond the realm of the mortals around us. In the language of today's world, this means nothing more than to hearken, in our various dilemmas, to the voice that speaks to us from the depths of our conscience." That voice is now free to speak. Let it speak. Let it speak of the values and ideals that brought us to this point and that should guide us now to the future that awaits." She also held a meeting in Prague with leading NGOs who were addressing a range of issues critical to the new democracy. Mrs. Clinton lent her support to their important work. Mrs. Clinton visited the Olga Havel Foundation which focuses on the needs of the disabled and where she held a roundtable on long term health care issues. Mrs. Clinton held a discussion at the Charles University Vinohrady Hospital to highlight the importance of partnerships between U.S. hospitals and the Czech Republic. In October 1998, Mrs. Clinton returned to the Czech Republic, at the invitation of President Havel, to participate in Forum 2000 on Civil Society to address the challenges of building stronger democracies in a new era of globalization. She keynoted the forum, and said: "As with every age, we have to take the world as we've been given it, not as we wish it were, either with a too optimistic or pessimistic vision. And we have to create conditions in which democratic governments become even more the norm so that all citizens are given a stake in their future. In which free markets benefit all people and not just a privileged few. And in which a vibrant civil society fosters free and active citizens who will, after all, ultimately determine our common human fate in the next millennium." [HRC Remarks, 10/13/98] 10/29/00 12:35 PM FIRST LADY HILLARY RODHAM CLINTON A COMMITMENT TO BUILDING DEMOCRACY IN HUNGARY On July 6-8, 1996, Mrs. Clinton visited Hungary to underscore strong U.S. support for the new democracy. Mrs. Clinton met with then-President Arpad Goncz and with Prime Minister Gyula Horn to praise Hungary's new democracy, and she placed flowers at the statue of Imre Nagy, the martyred leader of the 1956 revolution. Mrs. Clinton held a roundtable with Roma families, representatives from the local government and NGOs where she said "Here in Hungary, the transformation from authoritarianism to freedom is especially impressive The Hungarian people have embraced the values of democracy and are assuming the responsibilities that go with it." [UPI, 7/7/96] At a meeting with women leaders hosted by the Primavera organization which works to strengthen networking and professional opportunities for women, Mrs. Clinton urged further development and support of programs that focus on training emerging women leaders and workers. Finally, Mrs. Clinton visited the Semmelweis University Hospital, which has a world- class reputation for its children's cancer clinic and spoke about the importance of quality pediatric health care. 10/29/00 12:35 PM FIRST LADY HILLARY RODHAM CLINTON WORKING FOR PEACE IN NORTHERN IRELAND "[N]othing can compare to the powerful voices I've heard here From every sector of society. Every age. Women and men. All blending into a powerful chorus calling for women to become full participants in a secure and democratic Northern Ireland. A Northern Ireland that people have hoped for, lived for, died for, and, yes, finally voted for. " --First Lady Hillary Rodham Clinton Belfast, Northern Ireland September 2, 1998 Hillary Rodham Clinton has worked tirelessly to build the peace in Northern Ireland. Through the establishment of "Vital Voices Northern Ireland," she has worked to strengthen the women of Northern Ireland - - Catholic and Protestant - - to participate more fully in the political and economic life of their society. The women of Northern Ireland have borne an enormous share of the trauma of the Troubles, and now their participation is essential for peace and reconciliation. Mrs. Clinton traveled to Ireland four times to help make a positive difference. Working for Peace in Northern Ireland by Empowering Women Bridging the Sectarian Divide. In November 1995, Mrs. Clinton organized a meeting on Lower Ormeau Road in South Belfast where there have been clashes between Orangemen and republicans during the summer marching season. She met with Joyce McCarten and other women who had lost family members in the Troubles and who came together across sectarian lines to help create a better life for themselves and their families. In Dublin, she spoke to a gathering of women from the north and the south and praised their courage in attempting to end the violence. [Press Association Newsfile, 11/28/95; 11/30/95; AP, 12/1/95] Promoting Conflict Resolution and Community Reconciliation. In October 1997, Mrs. Clinton returned to dedicate a scholarship program at the University of Ulster in memory of Joyce McCarten to further the work of women in conflict resolution and community reconciliation. Launching the Women's Vital Voices Initiative in Northern Ireland. In September 1998, Mrs. Clinton keynoted the Vital Voices conference that she had made possible, bringing together women from all over Ireland. In her address, she underscored why economic and democratic progress depend on women's progress. This Vital Voices conference marked the beginning of more widespread women's engagement in their society. In May 1999, Mrs. Clinton participated in a follow up Vital Voices meeting in Belfast with hundreds of women and was joined by hundreds more by video link from Craigavon, Londonderry and Cavan to hear about the progress they were making. She also met with the women members of the Northern Ireland Assembly at Stormont to support and encourage them. [AP, 5/12/99] Honored for Quest for Peace. In Galway, Mrs. Clinton received an honorary degree and the Freedom of the City - the first woman to receive the honor since Ireland won independence in 1922 - and spoke about all our obligations to each other in the continuing quest for peace. [Birmingham Post, 5/14/99] 10/29/00 12:36 PM Strengthening Women's Vital Voices in Northern Ireland The Vital Voices Democracy Initiative that Mrs. Clinton has championed provides women with the tools they need, such as skills-building, training in business and the political process, access to small loans, internships and mentoring programs. Many U.S. government agencies, corporations and non-profits have partnered with Vital Voices to bring much needed assistance which the women have specifically requested, including; Political training in coalition building, campaign organization, issue development and advocacy including special training for Parliamentarians. Assistance to help women in Northern Ireland better access labor market service and training opportunities, as well as child care. Community development training for leaders for Northern Ireland in rural and urban regions; paid internships in hotel and tourism industry, and training in other fields as well. Supporting Children in Northern Ireland In her visits to Northern Ireland, Mrs. Clinton has stressed how crucial peace is for the future generations, and announced several partnerships that support the needs of children in the region. Creating Safe Places for All Irish Children to Play. Mrs. Clinton organized a partnership between an American non-profit, KaBOOM, and a Northern Irish group, PlayBoard, to build a safe outdoor place in Belfast for all children to play. She participated in the groundbreaking for the playground in May 1999. "[T]his is not only about building play spaces but it is about bringing children together and giving them the opportunity to help be the architects of their own futures. Certainly the members of the new assembly and all the citizens of Northern Ireland will themselves be architects in building the kind of future that you want of peace and prosperity here. And we are doing it, all of us who care about the future of Northern Ireland, for the young boys and girls we see around us today. Thank you for taking yet another step forward to make that possible. [HRC, 9/3/98] Highlighting the Importance of Children in the Peace Process. Mrs. Clinton delivered a major address at the Generation 2000 Youth Conference in Belfast in 1997. She said "no one group in Northern Ireland will have greater influence on whether or not peace takes root and flourishes into the next millennium than the youth we seek to empower and encourage today [HRC, 10/31/97] Supporting Innovative Practices to Build Peace. Mrs. Clinton worked with and supported Project Children, a program in which Protestant and Catholic children come to the U.S. to live with American families and in the process get to know each other. 10/29/00 12:36 PM What Leaders and Others Are Saying About Mrs. Clinton's Commitment to Northern Ireland Bertie Ahern, Prime Minister of Ireland: "The First Lady has been a vital voice for peace in her own right, reaching out to many constituencies which had been marginalized, especially community and women's groups, and ensuring their enormous potential would no longer be overlooked First Lady, I want to thank you for the trips and the work and the dedication in the hours spent in Limerick and Galway and Dublin and Belfast and Armagh-all of which have helped us over these years-and the huge and the enormous contribution that you've made to the Irish peace process in your own right [American Ireland Fund Dinner, Washington, DC, 3/16/00] Loretta Glucksman, President of the American Ireland Fund: "From the very beginning of the Clinton administration's formidable effort towards peace in Ireland, Mrs. Clinton has sought out people from both communities, helping to ease differences and build consensus. She has worked with American Ireland Fund-supported projects with May Blood, Geraldine McAteer, Jackie Redpath, Pat Hume and Daphne Trimble, and of course, Joyce McCarten Her personal initiative, Vital Voices, is an ongoing opportunity to bring more women into mainstream politics throughout the world." [American Ireland Fund Dinner, Washington, DC, 3/16/00] May Blood, Chairperson of women's organization, Fair Play: "There have been hundreds of conferences in Northern Ireland, dozens of them for women, but the unprecedented Vital Voices Conference put the women of Northern Ireland on the world stage" Monica McWilliams, Women's Coalition Northern Ireland Assembly Member: "[The women] still speak highly of how when they were so broken with grief that somehow you managed to show them the power of the human spirit You had met [one woman] when she was campaigning for the Families of the Disappeared when no one was paying any attention to the issue. Your involvement played a part in having the body of her son returned [Vital Voices Northern Ireland] has provided women with the opportunities and skills that have enabled them to become key decision-makers, peace activists and agents of change. As a result women have lifted the baton. They have learned how to fight and compete. Now they are ready to govern and lead." [Irish Times, 9/24/99] Inez McCormick, Irish Congress of Trade Unions President: "We've just begun to experience the difficulties of power We honor what you have done, in defining the holding of power, not as the exercise of control, but the ability to affect change and empower others in doing so." [Vital Voices Conference, 9/98] Fiona Hughes, 17 year-old from Derry: "[Mrs. Clinton is] a role model to me and to young women all around the world She has shown that women, given a real voice, can make a lasting difference in their communities and in the whole world." [Vital Voices Conference, 9/98] Niall O'Dowd, Irish America Magazine's publisher: "No president or first lady ever particularly cared about this issue. She's the first first lady to ever go to Northern Ireland She knows the issue extremely well and deserves credit for it." [The Mirror, 3/15/00] 10/29/00 12:36 PM FIRST LADY HILLARY RODHAM CLINTON WORKING TO STRENGTHEN DEMOCRACY IN POLAND "Millions of Americans trace their origins to Poland. Yet our bonds are of more than blood, they are of brotherhood and sisterhood Indeed, it seems that the values of democracy and freedom are in the very fiber of our being - we Americans and Poles." First Lady Hillary Rodham Clinton Warsaw, July 3, 1996 First Lady Hillary Rodham Clinton visited Poland three times as goodwill ambassador. There she celebrated Polish and American friendship and our country's commitment to help Poland build its democracy and market economy. On her visits, she also advocated for women's progress, and praised programs that were working towards those goals. Mrs. Clinton also commemorated the memory of the Jews and others who perished in the Holocaust and lauded efforts to rebuild Poland's Jewish community. Advancing Democracy Building In 1996, Mrs. Clinton delivered a major address at Lazienki Palace in Warsaw where she highlighted the strong bonds between the U.S. and Poland. She extolled the work of non-governmental organizations in Poland, many of whom were represented in the audience, and she was privileged to announce a USAID grant to Polish NGOs to strengthen Poland's democracy by supporting public- private efforts to build civil society. In 1999, at Litewska Children's Hospital, Mrs. Clinton met with American and Polish business leaders and encouraged them to engage in philanthropic activities, such as their involvement in the children's hospital. In 1999, Mrs. Clinton addressed a major conference in Warsaw for democracy leaders from Central and Eastern Europe called "Partners in Transition: Lessons for the Next Decade" where she discussed how critical it is to choose democracy, despite the difficulties. She said "Now ten years ago, the United States shared in the celebration and euphoria that swept so much of Europe and into Central Asia, but we know very well that the story and the struggle did not end there. In fact, in many ways it was just beginning. Choosing the path of democracy, free markets, and freedom required great vision, courage, and moral leadership. Ten years ago it was not the obvious choice, nor was it the easiest. But today in so many of your countries, there is no question that the path of free markets and democracy is the right choice." Promoting Women's Progress During all of her visits to Poland, Mrs. Clinton held extensive conversations with women leaders from all sectors of Polish society and highlighted projects that have been supported by the United States government to help Polish women succeed in the new economy and in the political sphere. In Warsaw, she visited a successful textile factory and met with women in business who talked to her about the hurdles they still confront as well as their successes. Mrs. Clinton also worked closely with the wife of the Polish Ambassador to the U.S. to promote Breast Cancer prevention in Poland and she met with the Polish Breast Cancer coalition at the White House and in Poland. 10/29/00 12:35 PM Honoring the Past and Celebrating the Rebirth of the Jewish Community In an acknowledgement of the importance of remembrance, Mrs. Clinton paid respects to victims of the Holocaust when she visited the Auschwitz-Birkenaul Nazi death camp. On her trips, Mrs. Clinton also visited the Jewish Center in Warsaw and praised the fledgling rebirth of the community there. In 1999, she visited the Lauder Morasha School and recalled her previous visit: "Three years ago, at the Lauder Community Center, I sat with three generations of Poles. As we sat in the circle, I listened to the stories of people who told us with great emotion their discovery of their own Jewish roots. But roots, you know, are usually under ground, in the dark. Roots can only be seen by what they produce and what flowers from them. That is why this school and the others like it are so important. You are making it clear that the best way to combat the evil and violence that plagued this century is to teach children respect for one another and the way to live with that respect in the next century." Celebrating Poland's Heritage and Meeting Poland's Leaders During her three trips to Poland made on behalf of the U.S., Mrs. Clinton visited Warsaw and Krakow. She paid her respects at the Tomb of the Unknown Soldier and the Tomb of Tadeusz Kosciusko and she also visited Wawel Cathedral. She had a lively discussion with two of Poland's great intellectuals, the late Jerzy Turowicz and Czeslaw Milosz. She met with Polish leaders: former President Lech Walesa, current President Kwasniewski and Prime Minister Buzek. After her 1996 trip to Poland, Mrs. Clinton held a briefing in Washington for members of the Polish American community. 10/29/00 12:35 PM FIRST LADY HILLARY RODHAM CLINTON A COMMITMENT TO BUILDING DEMOCRACY IN ROMANIA On July 1-2, 1996, Mrs. Clinton visited Romania to underscore strong U.S. support for the new democracy. She made a number of stops in the country and met with the President and other political leaders. When she arrived, she greeted thousands of cheering residents in Bucharest at Revolution Square where she placed a wreath in memory of those who died in the anti- Communist struggle. "Standing on a tiny wooden platform Monday at a site that was at the heart of Romania's bloody democratic revolution, Mrs. Clinton brought a crowd of 3,000 to a roar with a few brief remarks. 'The United States, as it has since 1989, will stand with you and support you,' she said at Revolution Square. 'We believe in the future of Romania and we want to be your partners and your friends." [Associated Press (in Chattanooga Times), 7/2/96] Afterwards, Mrs. Clinton visited a pediatric AIDS center and met children who were stricken with AIDS, and she also visited an elementary school which was named for her. Mrs. Clinton also announced a major public-private partnership to support the first Romanian school for advanced nursing where she said "the US shares Romania's aspirations to join the western democratic family. We share your aspiration to build a free market economy and a society that respects human rights Romania has emerged from the darkness and the light of freedom shines upon it. This is the opportunity for Romania to fulfill its historic destiny. As you seize this opportunity, America will do her part to ensure your integration into the family of democratic nations. [AFP, 7/1/96] Mrs. Clinton met with non-governmental organizations (NGOs) about the import role they play in building the new democracy in their country. The groups were working on issues ranging from citizen participation to the environment. Mrs. Clinton also visited a village museum where she learned about Romania's history, traditions, and crafts. 10/29/00 12:35 PM FIRST LADY HILLARY RODHAM CLINTON A COMMITMENT TO BUILDING DEMOCRACY IN SLOVAKIA When Mrs. Clinton visited Slovakia for the first time on July 6, 1996, she focused her work on promoting democracy there and urged the Slovak government to give greater support to advocacy organizations and non-governmental organizations that work on a variety of human rights, education, environmental, media, medical and social projects. The government at the time was working to stifle the work of NGOs. She said: "I hope the government will reconsider its opposition to the work of NGOs Very often people who are working hard and doing what they think is right for the country don't want the necessary criticism that comes with democracy Any government that wants to make sure that democracy lives must understand that the NGO is a partner in that process." [AP, 7/7/96] She inspired NGOs to work for progress despite the difficulties. Mrs. Clinton also conveyed the same message to then-Prime Minister Vladimir Meciar. She also signed the Golden Book and in the company of President Michal Kovac, Mrs. Clinton addressed a large gathering of Slovaks in Primate Square. On October 6, 1999, Mrs. Clinton paid another visit to Slovakia on behalf of the U.S. Government, and at the invitation of the new government of President Shuster and Prime Minister Dzurinda. She again met with representatives of the NGO community to praise them for the role they played in ushering political and social progress since her last visit and to encourage them to keep working on building a strong, democratic civil society. The NGO community presented Mrs. Clinton with an award for her commitment to democracy and her support of democratic efforts in their country. As a result of Mrs. Clinton's strong support of the Slovak NGOs on her first trip, they went on to play a critical role in the election of a new Slovak administration, and are working to build civil society in Slovakia. On this trip, Mrs. Clinton also met with President Schuster, Prime Minister Dzurinda and toured Rabbi Chatam Sofer's Gravesite. 10/29/00 12:35 PM FIRST LADY HILLARY RODHAM CLINTON STRENGTHENING TIES BETWEEN THE U.S. AND GREECE First Lady Hillary Rodham Clinton twice visited Greece as First Lady to meet with Greek leaders and to highlight the friendship between our countries. On her first trip, on March 29-31, 1996, Mrs. Clinton delivered a major address at the Zappeion Assembly Hall hailing Greek contributions to Western culture and society and encouraging the development of a vibrant democracy. There she said: "A few hours ago I was at the Acropolis, feeling somewhat overwhelmed by its extraordinary beauty and by the history and culture it represents. [T]here is hardly any aspect of modern life that has'not been influenced by classical antiquity. Democracy demanded and depended upon the creative expression and vision of individual citizens. And ancient Greece provided the environment in which those citizens could flourish. Today, democracy remains our best hope for peace and prosperity around the world, particularly during this time of rapid global transformation. Now more than ever we need to be reminded of the lessons and legacy of those Greek democrats." [HRC Prepared Remarks, 3/29/96] During this visit, Mrs. Clinton held discussions with the President and Prime Minister of Greece and also met with many prominent women leaders. Mrs. Clinton also traveled to Olympia for the lighting of the Olympic flame and in celebration of the 100th anniversary of the Olympic games. This was a particularly symbolic act because the same flame was to travel to the United States for the 1996 Olympics in Atlanta. Mrs. Clinton made a second visit to Greece with the President on November 11, 1999. As honorary chair of the organization Plant Your Roots, devoted to the important challenge of reforestation in Greece, Mrs. Clinton was able to make a major announcement of money raised to plant approximately 1.5 million saplings throughout Greece, including one in her name. Mrs. Clinton talked about how much she would like to return to Greece "not only in the future to see my tree, but on many different occasions, and to see also the extraordinary progress that is occurring here in Greece continue and to see for myself the deepening ties and friendship between our countries and our peoples." [HRC Remarks, 11/20/99]. During this trip Mrs. Clinton also held a roundtable on women's issues. On two visits to Istanbul in 1996 and 1999, Mrs. Clinton was privileged to visit with his All Holiness the Ecumenical Patriarch Bartholomew I. On her first visit, the Patriarch took Mrs. Clinton and Chelsea on a tour of the cathedral. Mrs. Clinton wished to demonstrate continued U.S. support of the Ecumenical Patriarchate in Istanbul, as well as support for guaranteeing equal rights to the Turkish citizens of Greek origin in Istanbul. She also said that it was her sincere hope that a way would be found to reopen the Halki seminary to ensure the continued vitality of the church. Mrs. Clinton paid a second visit to the Ecumenical Patriarch with the President in 1999. Earlier, in October 1997, she had welcomed his All Holiness the Ecumenical Patriarch Bartholomew I to the White House during his visit to the U.S., and many Greek-Americans from across the country attended the reception in his honor. Mrs. Clinton attended a number of events to celebrate the ministry of Bishop Iakovos, including conveying her best wishes upon his retirement. In September 1999, Mrs. Clinton attended the enthronement ceremony of Greek Orthodox Archbishop of America Demetrios and offered remarks at the following celebration. 10/29/00 12:35 PM Clinton Presidential Records Digital Records Marker This is not a presidential record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff. This marker identifies the place of a tabbed divider. Given our digitization capabilities, we are sometimes unable to adequately scan such dividers. The title from the original document is indicated below. Breast Cancer Divider Title: The Breast and Cervical Cancer Treatment Act: What HRC and Her Staff Have Done to Push for Enactment 1) HRC and her staff fought to have the initiative ($220 million) included in the President's FY 2001 budget. (Podesta, Lew and Jennings can validate). There was some resistance to doing so because it carved out within Medicaid special treatment for the two diseases, but she and her staff prevailed. 2) Prior to this year, the bill had not moved; inclusion in the President's budget provided critical momentum. 3) Worked to get a radio address to highlight the proposal (2/5/00). (The President also mentioned the proposal in his 10/5/00 radio address on colorectal cancer). 4) Her staff worked continually to make sure the legislation was on the White House's radar screen and remained a White House priority. For example, her staff worked internally to make sure that passage of the legislation was listed among end-of-year Administration priorities. (See 10/6/00 fact sheet "President Clinton: Urging Congress to Put Progress over Partisanship in Addressing America's Priorities.") In addition, when the Domestic Policy Council compiled a list of the top remaining Administration authorization priorities - a list that was shared with Congressional leadership - the Breast and Cervical Cancer Treatment Act was listed. As a result, the White House kept up the pressure on Congress to enact the legislation. 5) When the legislation was in jeopardy in the House, her staff pushed internally to have the President call Speaker Hastert and urge him to move the bill. (See 10/5/00 topper: 10/5/00 11:27 A.M. EDT THE PRESIDENT: Good morning. I want to thank Senator Daschle and Congressman Gephardt and the distinguished members of the House and Senate who have come here today for a meeting on education. And I want to direct my remarks toward that and then call on Senator Robb and Representative Berkley to talk. But before I do, I would like to say a few words about the Breast and Cervical Cancer Treatment Act, which passed the Senate unanimously yesterday. This bill will help thousands of low-income women with cancer get the early, affordable treatment which can save their lives. I just spoke with Speaker Hastert and he said that he expected the bill to pass the House immediately, so that help can start flowing to women for whom it could be a matter of life and death. 6) Her staff has worked closely with the National Breast Cancer Coalition, the prime advocates of the bill, to strategize about how to get this bill enacted. (Fran Visco of the National Breast Cancer Coalition, at (202) 296-7477, can validate.) 7) Mrs. Clinton had extensive conversations with Congresswoman Anna Eshoo, one of the prime House sponsors, about the legislation. John Flaherty, Chief of Staff for Rep. Eshoo (225-8104), can validate this. He said he would validate the point that White House support, which Mrs. Clinton was instrumental in obtaining, was very important in passing the bill. Further, he will validate the point that including the initiative in the budget provided "critical momentum." 8) In July, Mrs. Clinton received an award from the National Breast Cancer Coalition for her leadership. FIRST LADY HILLARY RODHAM CLINTON PROMOTING WOMEN'S HEALTH AS AN ADVOCATE FOR BREAST CANCER AWARENESS First Lady Hillary Clinton has long been a champion of breast cancer research, detection, prevention and awareness. Like most women, she has been personally touched by breast cancer, having lost friends and family, including the President's mother, Virginia Kelley, to the disease. Based on her personal experience and her travels during her work on health care reform, the First Lady has gained a deep understanding of the need to combat breast cancer on multiple fronts. She has worked tirelessly to increase scientific research into the causes of cancer, expand research into technologies to better detect and treat breast cancer, improve efforts to provide women with insurance coverage, and increase public awareness of the need for prevention and detection. Prior to President Clinton's election in 1992, the First Lady was regularly meeting with advocates and planning ways to improve the federal response to breast cancer. In fact, during the 1992 Presidential campaign, the First Lady had a memorable meeting with representatives of the National Breast Cancer Coalition that would shape her views about the extraordinary commitment and resiliency of breast cancer survivors. The bus the advocates took to meet with the First Lady in Williamsburg, Virginia, broke down, requiring them to hitchhike, getting rides in sheriff's cars and trucks, to make it to the meeting on time. Since that time, Mrs. Clinton has developed a close working relationship with the National Breast Cancer Coalition, which has twice honored her for her efforts to eradicate the disease. DEVELOPING A NATIONAL ACTION PLAN TO FIGHT BREAST CANCER In October 1993, setting the tone for the aggressive efforts the Administration would take against breast cancer, the First Lady and President met with 300 advocates from the National Breast Cancer Coalition in the East Room of the White House. The President and First Lady discussed actions the Administration had taken to increase the federal commitment to combating breast cancer, including the creation of the Office of Research on Women's Health at the National Institute of Health (NIH) and the largest increase ever in funding for breast cancer research. They also committed to a National Action Plan on Breast Cancer, which would bring together health professionals, activists and government officials to develop a comprehensive strategy to eradicate breast cancer. At that meeting, the President and First Lady also discussed how the Administration's health reform efforts were designed to change the fight against breast cancer, by making sure that women were no longer treated as second-class citizens, and emphasizing disease prevention and detection. The Health Security plan - crafted by Mrs. Clinton, who served as the President's point person on health care reform - included a comprehensive benefits package would have covered, at no cost to the patient, routine clinician visits, including clinical breast exams. The mammography benefit, based on the consensus scientific evidence at the time, would have covered mammograms every two years - also at no cost to the patient - for all women over 50, and more frequent mammograms for women of high risk at any age. The plan itself provided flexibility for updating the benefits package to reflect new or better studies. Later that same month, the First Lady met with the President's Cancer Panel Special Commission on Breast Cancer to receive their final report and recommendations, which would provide part of the basis of the National Action Plan. In 1995, the First Lady attended the first meeting of the steering committee for the National Action Plan on Breast Cancer, which included consumer advocates, government officials and scientists, and was chaired by Fran Visco, President of the National Breast Cancer Coalition, and Dr. Susan Blumenthal, Deputy Assistant Secretary for Women's Health. The First Lady and her staff remained involved in the planning and execution of the Action Plan, which has been implemented through Department of Health and Human Services Office on Women's Health. INCREASING AWARENESS OF MAMMOGRAMS AND MEDICARE COVERAGE During her health care reform efforts, the First Lady traveled the country meeting with patients, health professionals, and providers to discuss America's health care needs. She learned that even though a mammography benefit was added to Medicare in 1991, fewer than 40 percent of women on Medicare used it. And, sadly, it was estimated that 30 percent of breast cancer related deaths among Medicare-age women could have been prevented by early detection and treatment. During 1995, Mrs. Clinton traveled to numerous senior centers and hospitals, conducting "listening sessions" on the Medicare mammography benefit -- meeting and listening to many older women. She learned that some women were reluctant to get screened because they were afraid the procedure would be painful or embarrassing; others didn't realize the test was covered under Medicare; and still others had never been told by their doctors that a mammogram was one of the most effective ways of detecting malignant breast lumps. After learning about these barriers, the First Lady dedicated herself to developing strategies for outreach and education on prevention and detection of breast cancer. Soon after, Mrs. Clinton and her staff began working with the Department of Health and Human Services to develop a public-private campaign to encourage women to get mammograms, as well as to highlight the Medicare benefit that far too few women took advantage of. She hosted a meeting in March 1995 with government officials, public relations specialists, and corporate representatives to discuss the structure for the campaign and ways to develop public and private support for it. About this time, a new report from the New England Journal of Medicine confirmed that fewer than half the eligible women over 65 were getting mammograms despite Medicare coverage, underscoring the need to encourage and educate older women about the benefits of mammograms and Medicare coverage. The First Lady's work culminated in an historic national public awareness campaign. Corporations across the country joined the effort, creating a powerful partnership between private industry and the government. In a May 1995 White House event, the First Lady kicked off the Medicare Mammography Awareness Campaign with participants from the listening sessions, corporate sponsors of the campaign, public relations professionals, officials from HHS, and representatives of consumer groups. Called the "Mama-gram" campaign, it included a number of promotion efforts centering around Mother's Day, such as greeting and floral card 2 inserts, department store and drug store billing inserts, store displays, grocery store bags, and public service announcements (PSAs). At the event, the First Lady unveiled two new PSAs - one voiced by her and another by President Clinton - with the slogan "Get a mammogram. It's a picture that can save your life." This event marked just the beginning of the First Lady's commitment to raising breast cancer awareness. The campaign continued after Mother's Day with additional PSA's and outreach efforts through Medicare carriers and state health departments, local aging agencies, and advocacy and professional groups. The campaign has continued to be a top priority for the First Lady, who has taped PSAs, and used her syndicated column to promote awareness. Later that spring, the First Lady participated in a forum on Medicare and Mammography as part of the White House Conference on Aging, a listening session designed to educate the conference attendees about the Medicare benefit and encourage them to take the mammography campaign back to their communities. In May 1996, one year after kicking off the successful mammography campaign, the First Lady hosted a White House meeting to highlight the efforts of the campaign and amplify the public- private partnership. The meeting included advocates, government officials, and corporate representatives, and featured renewed commitments from the campaign's corporate partners, including worksite mammography initiatives, new PSAs, and retail messages. In February 1997, the First Lady again continued her support for the Medicare Mammography Campaign, inviting corporate representatives to the White House to meet and discuss increased private sector support for the campaign. During National Breast Cancer Awareness Month, in October 1997, the First Lady joined the President in his weekly radio address to launch another year of the campaign, including new PSAs and new outreach to communities with low mammography utilization rates. She and the President also announced new regulations to ensure the safety and quality of mammograms. In July 1998, she again met with corporate sponsors of the campaign to encourage their ongoing support for the campaign and their worksite efforts to encourage employees to get mammograms. Throughout her efforts to increase public awareness, the First Lady has been inspired by the memory of women across the country she has met who struggled with the disease, and by the spirit of White House volunteer Miriam Alpert, who before she lost her life to breast cancer - continually encouraged others to get mammograms. INCREASING RESEARCH The First Lady has continually championed significant increases for the National Cancer Institute and other agencies to support research on breast cancer detection, treatment, and to seek a cure for the disease. From fiscal years 1993 to 2001, discretionary funding for breast cancer research, prevention and treatment has more than doubled - from $283 million to a projected $660 million in 2001. Investment in research has led to historic advances, including the identification of new breast cancer genes, and promising new treatments. In October of 1998, to mark Breast Cancer Awareness Month, the President and Mrs. Clinton hosted an East Room event with advocates and survivors to announce significant increases in breast cancer research and new efforts in the fight, including a major clinical trial of two new drugs with the potential to reduce the risk of breast cancer, and an expanded mammography outreach and education campaign, building on the public-private efforts the First Lady launched in 1995. In addition to working within the White House to ensure that the Administration's budget included increases for vital breast cancer research, the First Lady has also worked to garner support for privately funded research. She hosted a White House event in 1996 for the Nina Hyde Center for Breast Cancer Research, and has participated in many fundraisers, including serving as Honor Chair of the Fashion Footwear Association of New York "Shoes on Sale," which has raised over $1 million for the Virginia Clinton Kelley Research Center Foundation, in honor of the President's mother. In July 1998, the First Lady launched the new Breast Cancer Research stamp, the first "semipostal" stamp in U.S. history, a stamp from which the net proceeds above the cost of postage are earmarked for breast cancer research. She continues to support the stamp, which she uses for all her personal correspondence. LEGISLATION TO PROTECT BREAST CANCER PATIENTS The First Lady has been a strong advocate for legislation to ensure that women who have mastectomies are entitled to sufficient hospital stays from their HMOs, an issue the President championed in his 1997 State of the Union Address. In February 1997, she hosted a White House event with breast cancer advocates, survivors, and members of Congress and their staff to bring attention to the problem and build support for the legislation. She invited a Connecticut physician and a breast cancer survivor to talk about the problems of women who were forced to endure mammograms on an outpatient basis, or sent home from the hospital too soon, still groggy from anesthesia, in pain, and with drainage tubes still in place. She also announced, with Secretary Shalala, steps that Medicare was taking to protect Medicare patients and ensure that a doctor, not a Medicare managed care plan, decides what is appropriate care after surgery. In addition, the First Lady was a key voice behind the scenes within the Administration for inclusion in the President's FY 2001 budget of a new initiative to cover more low-income, uninsured women. The initiative would provide a new Medicaid option to the thousands of uninsured women whose breast and cervical cancer is detected through federally supported screening programs. NEW MEDICARE BENEFIT In 1997, the Administration proposed expanding the Medicare benefit to cover annual mammograms, without copay. Until that time, there was significant disagreement about whether to recommend mammograms for women under 50. In February 1997, The National Cancer Advisory Board formed a subcommittee to develop a clear recommendation for the National Cancer Institute. After a conference on the issue, the National Cancer Institute announced 4 recommendations that women aged 40 to 50 receive regular mammograms. As soon as there was consensus on screening for women under 50, the First Lady worked for an expansion of Medicare coverage, which was enacted in the balanced budget. The new benefit, which went into effect in 1998, now covers annual mammograms for all Medicare beneficiaries age 40 and over, without deductible. The First Lady has received numerous awards for her efforts to fight breast cancer: July 16, 1993 - Iris Cantor Humanitarian Award, which recognizes contributions to women's health. HRC was the first recipient of the award. The award luncheon supported the Iris Cantor Center for Breast Imaging at UCLA Medical Center. October 2, 1995 - Government Leadership Award from the National Breast Cancer Awareness Month Board of Sponsors and Zeneca Pharmaceuticals for her "outstanding initiative in launching efforts to educate all women about mammography, especially women eligible for Medicare." October 20, 1997 - SELF Magazine's Pink Ribbon Award. Awarded to both the President and First Lady, "in recognition of extraordinary contributions and dedication to the fight against breast cancer." September 28, 1999 - Public Leadership Award from the National Breast Cancer Coalition for her work to eradicate breast cancer. March 28, 2000 - "Woman of Courage" Award from Cedars-Sinai Research for Women's Cancers and Saks Fifth. The First Lady was honored for her commitment to eradicating women's cancers, including breast and ovarian. August 2000 - National Breast Cancer Coalition Honoree at Democratic Convention Reception for her efforts to eradicate breast cancer. 5 Clinton Presidential Records Digital Records Marker This is not a presidential record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff. This marker identifies the place of a tabbed divider. Given our digitization capabilities, we are sometimes unable to adequately scan such dividers. The title from the original document is indicated below. Children & Youth Health & Childcare Divider Title: Melanne- Hillary's Record on Education and alrendy notice Iwrate this quickly Early Learning Sametypos when Ill fix. (1) Increased National Attention on Early Childhood Development and Learning But, wanted you tohne it in use Hosted First-Ever White House Conference on Early Childhood Development and Learning - Hillary hosted this conference to focus more attention on new research on the you get important the first three years of life to a child's brain development. Hillary brought together early childhood experts, scientists, pediatricians, parents, religious leaders and called. children's advocates to discuss ways to encourage parents and other adults to focus attention on improving the cognitive development of young children (White House spone Conference, April 17, 1997; Washington Post, 4/17/97). v/secreting Results: This conference coupled with the White House Conference on Child Care led to the Administration's proposal to create an Early Learning Fund to They was who improve early childhood education and the quality of child care. Senators Stevens (R-Alaska) and Kennedy (D-MA) have introduced the bipartisan Early Learning Opportunities Act, a direct successor to the Administration's Early Learning extency Fund. This bill is expected to pass as part of final negotiations with Congress helpful being conducted this week (Stephanie Robinson on Senator Kennedy's staff can and will validate Hillary's critical role on this piece of legislation.) tulk to (2) Worked to Improve the Language, Literacy and Reading Skills of Young Children - the HIPPY - Hillary brought to Arkansas a program from Israel called HIPPY - the Home press if Instruction Program for Preschool Youngsters - to help parents learn how to be their we child's first and most important teacher. This program allows trained early childhood need min educators to work with parents in their homes to learn how to work with their child to stimulate cognitive development. Arkansas was the first state in the country to this to doso, program and it now has expanded to nearly every state. Hillary is a founding and now all sites, based in New York City. emeritus board member of HIPPY USA, which is the name given the national network of Thenk Results: There are now approximately 250 HIPPY programs in more than 25 states. A 1996 study conducted by the National Center for Jewish Women's -Ann Center for the Child found that children who had participated in HIPPY outperformed a random sample group through elementary school. In fact the study found that HIPPY children attended school more, scored higher on standardized achievement tests, and were perceived by their teachers as better students (Baker & Piotrkowski, 1996). Prescription for Reading - Launched a national effort to improve the literacy skills of young children by having pediatricians "prescribe" reading to infants and toddlers. Pediatricians, hospitals, health centers, book publishers and libraries came together to provide greater access to books for young children and ensure that more infants and toddlers are read to by their parents or other adults in their lives. The Partnership was spearheaded by Hillary Clinton and led by Scholastic Inc., First Book and Reach Out and Read. Results: Among the partnership's accomplishments are: (1) an increase from 150,00 to 750,00 children served by Reach Out and Read; (2) an increase from 500 to 4,500 doctors and nurses trained to "prescribe" reading; (3) contributions made by Scholastic and First Book of more than 235,000 books; and, (4) distribution of more than one million books by participating doctors. In support of this program, Hillary has launched Reach Out and Read programs in Baltimore, Chicago, Washington, DC, and New York City. (America Reads Challenge, U.S. Department of Education.) K-12 Education Reform (1) Title I reforms - Hillary worked with Secretary Riley at the beginning of the Administration to lay the ground work for the reform of Title I, the Federal government's largest effort to improve education for children in our highest poverty communities. Hillary met with Secretary Riley and discussed the need for better targeting Title I funds to low-income children and the need to reform the Title I system to ensure that all children are learning to high standards and are not being given a separate watered-down curriculum. These initial meetings led to continued conversations with Secretary Riley as he led the effort to reform Title I through the reauthorization of the Elementary and Secondary Education Act, Improving America's Schools Act of 1994. (Early 1993 - Secretary Riley will validate.) RESULTS: "Especially striking is the evidence that the lowest-performing students as well as students in the highest-poverty schools have made substantial gains. During the 1994 reauthorization of Title I, the largest Federal investment in high-poverty schools, this Administration pushed not only for high standards for all students, rich and poor, but also for better targeting of Federal funds so that students in the highest-poverty schools have the resources they need to meet these standards. As a result, Title I funds now reach 95 percent of the highest-poverty schools, up from 79 percent in 1993-94,[3] and these funds leverage State and local resources toward improving the academic achievement of students in Title I schools. Moreover, since Title I funds mostly go to elementary schools,[4] the achievement gains among fourth-graders and nine-year-olds in reading and math are particularly noteworthy. Test scores are going up among the very students who benefit from Title I. These gains also reflect the Administration's efforts to strengthen accountability under Title I and to help high-poverty schools become high-performing schools." (Dept. of Education Report, Challenging the Status Quo: The Education Record 1993-2000, May 2000) 2 (2) Ensuring that all Children Learn to High Standards - Hillary worked on the establishment of high academic standards in Arkansas and brought her experience to Washington. In 1993 and early 1994 she advocated for the Goals 2000 legislation to ensure that all states would establish standards and have the supports to implement them (NEA annual convention 7/5/93, school event with teachers and children in Los Angeles, 1/27/93, signing ceremony for Goals 2000 legislation 3/31/94). Hillary was one of the Administration's top officials working on the implementation of standards and the development of the proposal of a voluntary national test in reading and math for all children. She attended a brainstorming meeting with the President and Secretary Riley to discuss implementation in March 1997 and met with the press following the meeting. Subsequently, Hillary kept in contact with Secretary Riley to discuss implementation and push for the voluntary national test (White House scheduling records and Secretary Riley can validate.) (CAMPAIGN TO ADD) AR reforms on standards and teacher quality - modernizing education (3) Charter Schools - Hillary was one of the most vocal advocates for public school choice and the development and expansion of the Federal government's efforts to support the development of more high-quality charter schools. Hillary has participated in roundtable discussion with school administrators, teachers, students, and teachers to discuss how to improve the availability of high quality charter schools (roundtable with President, 9/17/97). Hillary also led the Administration's efforts to help the District of Columbia establish an effective charter school program. In August of 1998, she led a forum designed to share information on effective strategies from successful charter schools and timely technical information from the District. She also worked on behalf of the Administration to lobby the Congress and the House Appropriations Committee to add an additional $20 Million in federal funding for DC public charter schools, while at the same time, fully funded D.C.'s public schools (need validators - Neera is this true?). Results: A February 2000 report from the U.S. Department of Education shows that more than 250,000 students nationwide are now enrolled in charter schools in 30 states and the District of Columbia. (Thirty-six states and the District of Columbia have now passed legislation allowing the creation of charter schools. When President Clinton was first elected, there was only one public charter school open in the United States. This year, according to today's report, 1,605 charter schools were in operation as of September 1999 -- more than halfway to the President's goal of 3,000 charter schools. National leadership has played a key role in this rapid growth: federal funds have supported the creation of individual charter schools and helped disseminate best practices and strategies among these schools. (White House Press paper, 2/11/00) 3 (4) Improving After-School Opportunities for Children and Families - Recognizing the need of working parents, who want a safe and education place for their children to learn and grow after-school, Hillary ensured that after-school was a critical part of the Administration's unprecedented Child Care initiative of 1998. Hillary called for provide after-school opportunities for up to half a million children per year by expanding the 21st Century Community program by $800 million over 5 years. Results: Hillary's advocacy combined with a national cry for action from parents has led to the expansion of the afterschool program, 21st Century Community Learning Centers, from $1 million in 1995 to a proposed $1 billion in the President's FY 2001 budget. In 1999 alone, 850, 000 children are being served and if the Clinton Administration wins their budget request, the program will be able to serve over 2 million children (White House FY2001 budget, February 2000). Improving Access to College (1) Advocated for the College Opportunity Tax Credit With the strong advocacy of Hillary and Senator Schumer, President Clinton proposed a College Opportunity Tax Cut costing $30 billion over 10 years to provide tax relief for millions of families struggling to make college more affordable. When fully phased in, the proposal would give families the option to claim a tax deduction or a tax credit on up to $10,000 of tuition and fees for any post-secondary education including college, graduate study, or training courses. In general, the proposal would provide up to $2,800 annually in tax relief per family. In order to expand this tax cut to more families, the College Opportunity Tax Cut would phase out for married filers with incomes between $100,000 and $120,000. The College Opportunity Tax Cut builds on the Lifetime Learning tax credit that President Clinton signed into law in 1997. In addition, the President's FY2001 budget contains other education tax incentives that were originally proposed in the FY2000 budget, including $1 billion over 10 years to provide tax-free treatment for employer-provided graduate education and increased deductibility of student loan interest. Improving School to Work and Workforce Training In the 1980s, Hillary served on the board of the National Center on Education and the Economy and worked on the bipartisan Commission on the Skills of the American Workforce to explore ways America could improve the skills and wages of its workforce. The Commission developed a report of recommendations, "America's Choice: High Skills or Low Wages." As a result of this work, Hillary testified in front of Congress in October of 1991 to share the reports recommendations: (1) America's students need to learn to high standards, including voluntary educational occupational standards (2) America needs a School-to-Work program to help students gain the skills and training they need; (3) improve the training and education of the workforce. (Congressional Record, October 1, 1991) Results: Hillary worked with Senator Kennedy and his staff to draft the High Skills Competitive Workforce Act of 1991, S. 1790 (Nick Littlefield, Kennedy's former Chief 4 of Staff can validate, 617/832-1000). This bill led to three Federal laws advocated and supported by the Clinton Administration: (1) School to Work Partnership of 1994; (2) Goals 2000, which created the National Skills Standard Board; (3) Workforce Investment Act of 1998. (NewYork Newsday, 8/11/2000) 5 FIRST LADY HILLARY RODHAM CLINTON A HISTORY OF COMMITMENT TO THE NEEDS OF CHILDREN For the last 30 years, Hillary Rodham Clinton has demonstrated support for policies in health and education that promote the well being of children. As First Lady, she has advocated for the needs of America's working families and their children on a variety of issues including: CHILDREN'S HEATH Urging Drug Companies to Provide Adequate Testing for Children. In 1997, the First Lady began to fight for appropriate testing and labeling of prescription and over the counter drugs for children. As a result of her efforts, new pediatric labeling regulations and the FDA Modernization Act were enacted by the Clinton Administration in 1997. In the 18 months since these initiatives have been implemented, the information available to both parents and physicians about the appropriate use of medications for children has improved. Research has been completed on 19 drugs, resulting in new safety information being added to six drugs with changes expected for the other 13. Studies of an additional 125 drugs are already underway. Leading Efforts to Enact State Children's Health Insurance Program. The First Lady led efforts to create the $24 billion State Children's Health Insurance Program - the single largest investment in health care for children since the passage of Medicaid in 1965. This new program will provide meaningful health care coverage for up to five million currently uninsured children - including prescription drugs, vision, hearing, and mental health services. Working to Ensure that Uninsured Children are Enrolled in Medicaid and S-CHIP. The First Lady was personally involved in the launch of a broad-based, bipartisan, public-private coalition called Insure Kids Now to use a variety of means to educate and assist families in insuring their children through either Medicaid. Initial activities included: unveiling the "1-877- KIDS NOW" hotline, a national toll free number developed to provide state-specific information about Medicaid and CHIP to families in all 50 states; running public service announcements on national television and radio about Insure Kids Now; and printing the Insure Kids Now toll free number on commonly used products. Working to Raise Child Immunization Rates to An All Time High. The First Lady has worked hard to make sure that vital children's vaccines are available and affordable. Mrs. Clinton helped launch the Childhood Immunization Initiative and helped secure passage of the Vaccines for Children Program in October 1994, designed to provide free vaccines to uninsured and under-insured children. Supporting Children's Hospitals. The First Lady advocated for funding in last year's budget to support the training of physicians at freestanding children's hospitals, and worked to double the funding for the graduate medical education program in the Administration's FY 2001 budget. Promoting Research and Funding on Specific Children's Health Issues. The First Lady has advocated for increased research on juvenile diabetes and epilepsy. Last year, Mrs. Clinton launched the Administration's comprehensive childhood asthma initiative and helped secure funding for the EPA to study the causes of asthma and promote awareness of the disease. She also inaugurated a public outreach campaign for Pediatric AIDS at the White House. CHILD CARE AND EDUCATION Promoting Child Care and Early Learning. The First Lady has worked tirelessly to improve access to safe, affordable, high quality child care for America's working families and to ensure that children enter school ready to learn. She chaired the White House conferences on Child Care and Early Childhood Brain Development, which led to the Administration's proposal for substantial and historic new investments in child care, Head Start, and other programs serving young children. Supporting the Neediest of Children. As the Administration's most prominent advocate on foster care and adoption, the First Lady has worked on behalf of the over 500,000 children who live in foster care because of abuse and neglect. She has promoted the adoption of children living in foster care and worked for passage of the Adoption and Safe Families Act of 1997, and the Foster Care Independence Act of 1999, two pieces of landmark legislation which reformed our nation's child welfare system by putting considerations of children's health and safety first. Keeping Schools Safe. The First Lady has urged Congress to pass legislation that would keep guns out of the hands of children, co-hosted the White House Conference on School Safety, and helped to launch the National Campaign Against Youth Violence. Giving Parents the Tools They Need To Protect Their Children. The First Lady has long believed that parents should have control over their children's exposure to media. She hosted a White House convening on children's television, advocated for increased educational programming for children, led a round-table discussion with the President and Vice President on the V-Chip, and strongly advocates the establishment of a voluntary uniform ratings system for all forms of media. Expanding School Choice. The First Lady has long encouraged the establishment of public charter schools to give parents more choice in schooling, has and worked to secure funding for charter schools in Washington DC. Expanding After-school and Summer Learning Opportunities. Recognizing the importance of out-of-school hours, Hillary Clinton has fought for the Administration's most recent proposal to invest $1 billion in the 21st Century Community Learning Centers program. Hillary Clinton: A Leading Advocate for the Nation's Neediest Children A Record of Accomplishment Adoption and Foster Care As the Administration's most prominent advocate on foster care and adoption, First Lady Hillary Rodham Clinton has worked on behalf of the over 500,000 children who live in foster care, and has led this Administration's unprecedented record of promoting the well-being of children in foster care and providing them with permanent, loving homes. Mrs. Clinton traveled the country to meet with children who were aging out of foster care, as well as those who were on the road to being adopted. She convened policymakers, advocates, heads of foundations, and others to develop innovative legislative and regulatory solutions to the meet the needs of thousands of children waiting to be adopted. The First Lady has promoted the adoption of children living in foster care, worked to break down racial and ethnic barriers to adoption, worked for passage of the Adoption and Safe Families Act of 1997, and worked to provide additional resources to children aging out of the foster care system through the Foster Care Independence Act of 1999. These two pieces of landmark legislation reformed our nation's child welfare system by putting considerations of children's health and safety first. Background Adoption and Safe Families Act of 1997: The, Adoption and Safe Families Act helps thousands of children waiting in foster care move more quickly into safe and permanent homes. This overwhelmingly bipartisan legislation was based in large part on the recommendations of the Administration's "Adoption 2002" report, which had the central goal of doubling the number of adoptions to 56,000 by the year 2002. Already, the total number of adoptions rose to 36,000 in 1998 from 28,000 in 1996, on track to meet Administration's goal. This 29 percent increase is the first significant increase in adoptions since the national foster care program was established nearly 20 years ago. The Adoption and Safe Families Act makes clear that the health and safety of children must be the paramount concerns of state child welfare services. It sets swifter time frames for making permanent placement decisions and terminating parental rights for children. For the first time, states have financial incentives to increase adoptions. Children with special needs and ongoing medical needs are ensured health care coverage. Federal funds continue for programs that work to keep families together when it is appropriate and safe to do so. Foster Care Independence Act: Nearly 20,000 young people leave foster care each year when they reach age 18 without an adoptive family or other guardian. Without the emotional, social and financial support that families provide, many of these youth find themselves inadequately prepared for life on their own. Studies show that within two to four years of leaving foster care, only half have completed high school, fewer than half are employed, one-fourth have been homeless for at least one night, 30 percent do not have access to needed health care, 60 percent of the women have given birth, and less than one in five are completely self-supporting. The Foster Care Independence Act of 1999 provides additional funding to the Independent Living program which offers older youth in foster care educational, vocational and employment training, daily living skills, substance abuse prevention, and connections to dedicated adults as mentors. The bill based on the Administration's plan, enables the program for the first time to include support for room and board, and provide states with the option to offer these young people Medicaid until their 21ˢᵗ birthday. In addition, the bill increases the asset limit and allows youths to have $10,000 in savings and still be eligible for foster care payments, so that they can save for college, an apartment or other needs that are critical for successful independence. Finally, the bill establishes accountability for states in implementing their programs by requiring data collection and evaluation. A RECORD OF ACCOMPLISHMENT FOR FOSTER CARE AND ADOPTION. With the signing of the new Foster Care Independence Act, the Administration adds to an unprecedented record of promoting the well-being of children and providing them with permanent, loving homes. In 1998 there were a record 36,000 adoptions from foster care, the first significant increase in the history of the program. From 1996 to 1998, the number of adoptions nationwide rose 29 percent -- from 28,000 to 36,000 -- and is on a pace to meet the President's goal of 56,000 adoptions in 2002. Among the President's other steps to improve child welfare and encourage adoption: Increasing the Transitional Living Program. In the last budget, the Administration secured a 40 percent increase in the Transitional Living program, which provides funds to local community-based organizations for residential care, life skills training, and other support services to homeless adolescents. The program will now be funded at $20.7 million. Enacting the Adoption and Safe Families Act of 1997. Based on the Administration's Adoption 2002 report, this landmark law made the health and safety of children a clear priority, provided the first-ever financial incentives for states to increase adoptions, tightened the time frames for making permanent placements of children, and removed other barriers to adoption. Making Adoption Affordable. In 1996, the President enacted a $5,000 tax credit for families adopting children, and a $6,000 tax credit for families adopting children with special needs. In the Balanced Budget Act of 1997, the Administration provided more support for families who adopt with a $500 per-child tax credit. And under the Family and Medical Leave Act, parents can take time with a newly adopted child without losing their jobs or health insurance. Breaking Down Racial and Ethnic Barriers to Adoption. New inter-ethnic adoption provisions signed into law by the President ensure that the adoption process is free from discrimination and delays on the basis of race, culture and ethnicity. Giving States Flexibility and Support. This Administration has given 25 states waivers to test innovative strategies for improving state child welfare systems. The Administration has provided states technical support to improve court operations and grants to support local adoption projects, and has also secured federal funding for the Promoting Safe and Stable Families program to serve at-risk children and families. Using the Internet to Promote Adoption. In November 1998, the President issued a directive to the Department of Health and Human Services to expand the use of the Internet as a tool to find homes for children waiting to be adopted from foster care. HHS will develop a national Internet site by the year 2002. ** Remarks/Columns Attached Children & Families: Foster Care and Adoption Leadership in Adoption and Safe Families Act of 1997 and Adoption 2002 Initiative Received HHS National Progress Report on Adoption which demonstrated significant increases in the national adoption rate (9/24/99) ** Bill signing ceremony of Adoption and Safe Families Act (11/19/97) ** Leadership in enactment of Adoption and Safe Families Act incorporating key recommendations for Adoption 2002 report (including internal meetings and congressional outreach) Berkeley, CA speech on significance of Adoption and Safe Families Act (11/24/97) Leadership in development of HHS Adoption 2002 report- with legislative and administrative recommendations- as required by POTUS Executive Memorandum Adoption 2002 Report Presentation by HHS to the President at Valentine's Day event (2/14/97) ** Leadership in development of Executive Memorandum on improving foster care and adoption Executive Memorandum issued at Oval Office POTUS radio address with foster care families (12/14/96) Convened Foundation Leaders to discuss foster care issues (8/2/96) ** Columns on bill (11/20/97 & 11/18/97) Leadership on Foster Care Independence Act of 1999 Bill signing ceremony of Foster Care Independence Act (12/14/99) ** Leadership in development and enactment of Bill Event with Mrs. Gore announcing new support for Transitioning Foster Care Youth (1/29/99) ** Destination Future Conference speech on emancipation from foster care (9/11/98) ** Roundtable discussion with California Youth Connection members on emancipation from foster care (11/24/97) WH Event to Unveil FY2000 Budget Proposal Adoption Promotion and Foster Care Improvement Campaign Appeared on the Rosie O'Donnell Show on Foster Care (5/8/00) Children's Action Network Adoption Event (12/20/99) Participated in the Jewish Child Care Association's 175th Anniversary Celebration, New York (4/19/99) Dave Thomas Adoption Law Symposium Video (2/5/99) White House event to mark Adoption Month (11/24/98) ** National Committee to Prevent Child Abuse award and speech (10/6/98) Speech at Kellogg Foundation Family for Kids Conference (6/25/97) National Council on Adoption Speech (4/16/97) Mother's Day Adoption Roundtable with adoptive mothers and children (5/10/96) National Adoption Month event at the White House (11/13/95) ** Remarks/Columns Attached Sustained theme in books and various columns (2/3/99, 9/29/99, 9/23/98, 2/10/98, 11/25/98, 11/18/97, 6/24/97, 12/17/96, 5/14/96, 7/30/95) ** Leadership on other key legislation Adoption Tax Credit and MEPA strengthening (1996) FMLA covering time off for adoption (1993) Multi-Ethnic Placement Act (1994) HRC CHIP Chronology 1994 After the election and the failure of health care reform, the President wrote to Newt Gingrich outlining health care goals and priorities. Expanding insurance coverage for children was one of the issues raised. 1995 Republicans took over the House, and started the push to block grant the Medicaid program. The President vetoed the attempts, and shut down the government HRC was a vocal opponent of block granting Medicaid, which she argued would have undermined the Medicaid entitlement and been particularly harmful to children. Block granting Medicaid was also an issue in welfare reform. The President vetoed several welfare reform bills because they would have undermined the Medicaid entitlement; HRC opposed these efforts as well. 1996 The Health Insurance Portability and Accountability Act (Kennedy-Kassebaum) enacted. 1997 The Administration's children's health proposal was included in both the FY 1998 budget and the State of the Union address. HRC was a strong advocate for the program, talking to HHS (she convened a meeting with Shalala), and internally, making sure that OMB, DPC and NEC worked together to develop and promote the proposal. HRC was in close contact with Kennedy as he pushed the Kennedy-Hatch proposal, which the Administration supported. (There were many debates about whether to have a Medicaid expansion or to have a separate private insurance option). May 1997 column about children's health insurance needs. HRC discussed the Administration's efforts to ensure that the children's health proposal remained part of the balanced budget. She said that plan and others on the Hill were a good start, but encouraged Congress to create a plan to ensure that all children are covered. June -- National Governor's Association speech Budget negotiations - CHIP was one of the last remaining issues. The White House insisted on $24 billion over 5 years and secured that amount. August 5 - the President signed the Balanced Budget, which included CHIP. That same day, recognizing that the success of CHIP depended on state implementation and parents enrolled their children, HRC wrote an opinion piece for the New York Times about CHIP implementation and outreach to parents. She urged states to participate in the program, and called for a joint effort, involving the Federal government, states, localities, advocacy groups, foundations, health care providers, insurers and businesses, to work to inform families about insurance options for their children. Also on August 5, HRC wrote her column about the Balanced Budget Act and mentioned the children's insurance provision (only one paragraph of the column). Outreach/Implementation Efforts Recognizing that one of the key reasons that SO many eligible children go uninsured is a lack of awareness of Medicaid and CHIP options, HRC convened several meetings with corporate leaders, volunteer organizations, and media groups to develop an outreach campaign. February 1998 - the President and HRC initiated the CHIP outreach campaign, and directed several Federal agencies to develop ways to do outreach. 2/24/98 column on the need to notify parents of CHIP, and announcing the Administration's outreach initiatives. 7/9/98: HRC convened a meeting of corporate partners -- 30 representatives from major corporations-all of whom had made specific commitments toward a private sector outreach campaign. The centerpiece of the event was the unveiling of a national ad campaign. America's Promise, Colin Powell's group, was a partner in developing the media campaign. The Ad Council committed to developing at least one ad. 2/2/99: With the President, HRC launched the nationwide "Insure Kids Now" campaign aimed at enrolling eligible but uninsured children in Medicaid and CHIP. The campaign included commitments from major radio and TV networks to broadcast PSA's, and commitments from consumer product manufacturers to print the new toll- free number on commonly used products. The event launched the toll-free "1-877- KIDS-NOW" hotline, and previewed HRC and NBC PSA's. These outreach efforts are ongoing. FIRST LADY HILLARY RODHAM CLINTON A STRONG COMMITMENT TO OUR NATION'S CHILDREN'S HOSPITALS As part of her lifelong commitment to the health and well-being of our nation's children, Hillary Rodham Clinton has fought hard to sustain and improve children's hospitals throughout the country. She played a pivotal role in securing unprecedented funding increases for pediatric medical training at independent children's hospitals and helped underscore the vital services such hospitals provide in communities throughout the United States. Mrs. Clinton's first experience with children's health issues dates to her first year at Yale Law School. After reading an article in Time magazine about child advocate Marian Wright Edelman and her lobbying group, the Washington Research Project (which later evolved into the Children's Defense Fund), Mrs. Clinton contacted Edelman and secured an internship with the organization for the summer. After finishing law school, Mrs. Clinton spent an additional year at Yale studying children's development and laws that affect children at the Yale Child Development Center. Her experience in these early years would set the stage for a lifelong commitment to promoting the health and well-being of our nation's children. Mrs. Clinton continued her work on behalf of children while serving as First Lady of Arkansas. She served as an advocate through her work for many children's organizations, including the Children's Defense Fund and the Carnegie Council on Children. From 1988 to 1992, she also sat on the board of the Arkansas Children's Hospital, which deepened her appreciation for the important services such hospitals provide to families and communities as well as the invaluable training they offer to medical students. As First Lady of the United States, Hillary Clinton has continued her efforts to promote and support children's hospitals and the vital role they play in our nation's health care delivery system. Mrs. Clinton has visited more than 20 children's hospitals around the country to highlight their contributions and the essential role independent hospitals play in the education of future pediatricians. The First Lady also has underscored the unique challenges faced by children's hospitals, which train nearly 30 percent of all pediatricians and nearly half of all pediatric specialists, but unlike other teaching hospitals have received very few federal funds for physician training. For example, in 1999, regular teaching hospitals received an average of $76,000 in federal graduate medical education (GME) funding per resident, while children's hospitals received an average of $400 per resident. These inequities have exacerbated the already precarious financial position of children's hospitals, which often serve the poorest, sickest and most vulnerable children. The First Lady, recognizing the need for more federal support for children's hospitals, has served as their champion within the Administration. In 1998 and 1999, Mrs. Clinton worked with White House staff and the Office of Management and Budget to develop a key proposal to greatly increase their federal funding. Because of her strong leadership, the President's 2000 budget included an unprecedented $40 million for GME at the nation's independent children's hospitals. In January 1999, the First lady convened a White House meeting with HHS Secretary Donna Shalala and senior executives from almost 30 children's hospitals to discuss graduate medical training and to announce the Administration's new commitment. The First Lady continued to work to underscore the importance of the proposal and closely monitored the appropriations process to ensure Congress included it in its bill. When the funding was omitted, she took steps to ensure that the Administration's policy statement to Congress on the bill urged the Senate to fully fund the $40 million request. Her vocal advocacy was instrumental to the inclusion of the funding in the final version of the legislation. In December 1999, along with representatives of several of the nation's children's hospitals, the First Lady participated in the Oval Office signing ceremony for the Healthcare Research and Quality Act of 1999, which authorized the increase in federal funding for graduate medical education at children's hospitals. At the signing, the President praised the First Lady for her leadership in championing the work of these hospitals and the critical services they provide to families and to medical students. The First Lady has continued her efforts on this issue, working to secure further increases in funding in the fiscal year 2001 budget. She has also continued to urge Congress to take more steps to invest in our children's health. FIRST LADY HILLARY RODHAM CLINTON PROMOTING ACCESSIBLE AND AFFORDABLE QUALITY CHILD CARE First Lady Hillary Rodham Clinton has served as the Administration's most prominent voice on behalf of children and working parents. As an advocate for families for nearly 30 years -- and having been a working parent herself she knows the importance of affordable, quality child care to working families. Mrs. Clinton's vocal leadership has led to a more than doubling of child care funding over the past seven years, the participation of hundreds of thousands of children in enriching and safe after-school opportunities, and a better understanding by the nation's businesses that good child care makes economic sense. Senator Christopher Dodd of Connecticut, one of the Senate's greatest advocates for children, once said of Mrs. Clinton's leadership on behalf of children's programs: "I don't call the President, I don't call the Office of Management and Budget, I don't call the chief of staff, I call the First Lady." The First Lady began her work on children's issues during her first year at Yale Law School. After reading an article in Time magazine about child advocate Marian Wright Edelman and her lobbying group, the Washington Research Project (which later evolved into the Children's Defense Fund), Mrs. Clinton contacted Edelman and secured an internship with the organization for the summer. After finishing law school, Mrs. Clinton spent an additional year at Yale studying children's development and laws that affect children at the Yale Child Development Center. Her experience in these early years would set the stage for a lifelong commitment to a wide range of children and family issues, including the importance of quality child care both to working families and for the healthy development of children. While First Lady of Arkansas, Mrs. Clinton served as chair of the board of directors for the Children's Defense Fund and on the board of directors for the Child Care Action Campaign in New York, and worked closely with the Carnegie Council on Children. Through each of these efforts, Mrs. Clinton helped raise awareness of the need for quality child care in the country, particularly as the percentage of women in the workforce continued to climb. She also founded Arkansas Advocates for Children and Families, served as president of the Arkansas Single Parent Scholarship Fund Program, and brought the Home Instruction Program for Preschool Youngsters to Arkansas. These professional experiences helped lay the groundwork for Mrs. Clinton's child care accomplishments as First Lady of the United States, but no lesson taught her more about the issue than being a working mother. While she was fortunate to enjoy more options for child care than many other parents, as a working mother juggling, her law practice, her duties as First Lady of Arkansas and caring for a young child, her child care arrangements occasionally broke down. At those times, she relied on friends and neighbors, but was always struck by the difficulties so many women face in finding reliable, quality care for their children. In 1989, while serving as the board chair for the Children's Defense Fund, Mrs. Clinton traveled to France as part of a study group to draw possible lessons for the American child care system. France places a top priority on preparing children for school and life by ensuring that all children between 3-5 years old can attend free or inexpensive pre-schools and by preparing early childhood educators to help children develop critical social and cognitive skills. The trip highlighted for Mrs. Clinton the fundamental importance of affordable, high-quality child care to the health of the larger community. After becoming First Lady of the United States, Mrs. Clinton redoubled her efforts to improve the nation's child care system for parents and their kids. She helped shape the President's first budget, which called for greater investments in pre-school with significantly more funding for Head Start. In 1994, Mrs. Clinton worked to promote the U.S. Department of Labor's "Working Women Count" survey, which revealed that working women's top concerns were integrating their work and family lives and finding and paying for decent child care. That same year, the Carnegie Council on Children released their seminal report, "Starting Points: Meeting the Needs of Our Youngest Children." Mrs. Clinton had long supported the work of the Carnegie task force that developed the report. In 1994, she joined the council to release the study's findings, which documented many of her concerns about the lack of adequate care in the United States. Throughout 1995, Mrs. Clinton traveled the country-learning about the struggles working families face in finding quality child care for their children. The experience would make her profoundly aware of the importance of child care to a successful transition from welfare to work. In numerous speeches that spring to organizations such as the Child Welfare League of America, the First Lady urged Congress to provide families moving from welfare to work with the safety net of job training, job placements, Medicaid/benefits, Food Stamps, and child care. She would become one of the Administration's most effective advocates speaking publicly and behind the scenes to ensure that provisions for child care were included in the welfare reform bill that was signed into law in 1996. During this same period, Mrs. Clinton completed work on her book, It Takes a Village: And Other Lessons Children Teach Us, which was published in 1996. She wrote extensively about her experiences working on behalf of children and families, current research on children's development, and examples of the types of programs that help children grow into productive and healthy adults. She has donated all proceeds from her book to hundreds of organizations that work directly to support the growth and development of children and youth. In 1997, the First Lady began organizing the first-ever White House Conference on Child Care by continuing her research and holding numerous meetings with child care experts and advocacy groups to gather ideas. She also resumed her travels to explore how the private sector and the military were dealing with the challenges of child care, and she visited the University of Maryland and gave a major address on the issue. The White House conference, held in October of that year, incorporated many of the themes the First Lady had explored in her travels and in her many meetings with working parents. At the conference, the President and First Lady announced a series of initiatives, including: the creation of a child care working group to explore the role that businesses should play in providing child care; new outreach efforts to child care workers to help improve their education and training; a "National Crime Prevention and Privacy Compact," to help states share criminal history information about child care workers; and a manual to guide local communities in improving afterschool care. 2 In the 1998 State of the Union address and Administration budget, the President rolled out a major child care initiative that was crafted with significant input from the First Lady. The initiative aimed to increase investments in child care and Head Start, expand afterschool opportunities, increase child care research, give parents better tools to find quality care in their communities and identify strategies to boost the caliber of care. The First Lady worked tirelessly to promote the landmark initiative, launching public service announcements on Lifetime Television; touring some of the area's most successful child care facilities; and hosting panel discussions with working families around the country. Her staff also worked with key aides on Capitol Hill to build congressional support for the proposal. Legislation developed by the House Democratic Caucus on Child Care, unveiled that spring, incorporated many elements of the Administration initiative. In 1999, Mrs. Clinton joined the President and the Gores on a "Family Agenda" tour where she spoke on the issues of balancing family and work, improving child care, and improving support for long-term care givers. Later that spring, Mrs. Clinton visited "Just Us Kids" child care center in the nation's capital where she announced a study by the Consumer Product Safety Commission on how to identify and correct hidden hazards that exist in child care centers. She also launched Lifetime's "Caring for Kids" child care campaign. Both of these efforts were aimed at empowering parents with vital information on child care. Throughout 2000, the First Lady has continued to champion a broad range of improvements to child care, holding key meetings, hosting events, writing nationally syndicated columns and making speeches. She has continued to focus on the expansion of the Child and Dependent Care Tax Credit, tax breaks for businesses that offer child care, support for the Early Learning Fund and the "Early Learning Opportunities Act" a proposal to improve the quality of child care, and calling attention to the link between investments in child care and reduced crime. Mrs. Clinton's efforts over the past 8 years have left an indelible imprint on our nation's child care system. This year, Congress is expected to approve the President's request for $2 billion in child care subsidies to serve 2.2 million children; funding for Head Start has doubled since 1993; the after-school program has served 850,000 children and is expected to grow in the next year; and in 1999, the White House secured $10 million in the budget for research on child care. In addition, the First Lady was instrumental in the creation of an interagency task force to better coordinate afterschool resources; the launch of afterschool as an information resource on after-school funds and best practices; the establishment of a national hotline for parents on child care information; the development of more effective ways to protect our children in child care by improving background checks on child care workers. 3 DRAFT 9/6 FIRST LADY HILLARY RODHAM CLINTON SUPPORTING YOUNG PEOPLE IN THEIR DEVELOPMENT As First Lady of the United States, Hillary Clinton brought to the White House significant expertise on supporting children and youth in their development and a deep commitment to advancing the position of young Americans, particularly those in need. As a result, she has worked behind the scenes and before the public on such issues as youth violence, national service, after-school care, and teen pregnancy. She has been a key player in developing legislation in these and other areas affecting youth, and by organizing and appearing at hundreds of public events on these issues she has helped to raise their visibility and make positive youth development a national priority. The First Lady began her work on the development of children and youth during her first year at Yale Law School. After reading an article in Time magazine about child advocate Marian Wright Edelman and her lobbying group, the Washington Research Project (which later evolved into the Children's Defense Fund), Mrs. Clinton contacted Edelman and secured an internship with the organization for the summer. Her experience there would set the stage for a lifelong commitment to a wide range of children and family issues. During her tenure as First Lady of Arkansas, Mrs. Clinton served as chair of the board of directors for the Children's Defense Fund, and as a board member of other influential national organizations concerned with youth, including the "I Have a Dream" Foundation, Children's Television Workshop, and Public/Private Ventures, whose mission is to improve the effectiveness of social policies, programs and community initiatives, especially as they affect youth and young adults. She also played a leadership role in Arkansas on behalf of youth, founding Arkansas Advocates for Children and Families, serving as president of the Arkansas Single Parent Scholarship Fund Program and as a board member of the Arkansas Children's Hospital and New Futures for Little Rock Youth. Building opportunities for youth. In 1988, Mrs. Clinton served on the William T. Grant Foundation Commission on Work, Family and Citizenship, best known for its seminal report, The Forgotten Half. This report was widely circulated on Capitol Hill, and brought to the attention of Congress the situation faced by the more than 50 percent of the nation's youth who do not go to college. The report advocated for family leave policies, school-to-work programs, more youth service opportunities, increased student aid, expanded Job Corps, and the development of mentoring programs. These recommendations all became significant policy achievements of the Clinton Administration, often with the First Lady as the most prominent advocate working to transform these recommendations into national policy. Also in Arkansas, Mrs. Clinton served on the board of directors of the National Center on Education and the Economy and as co-chair for implementation of the Center's Commission on Skills of the American Workforce. In this position, she worked closely with a bipartisan group of prominent experts, including former Reagan Secretary of Labor Bill Brock, calling for changes in the way America trained its workforce to prepare for a rapidly evolving global economy. After she and her colleagues traveled across the country advocating for the recommendations in the Commission's report, "America's Choice: High Skills or Low Wages!," and with the help of the new Clinton Administration, many states and the federal government adopted the report's proposals. Federal legislation signed into law included the Workforce Investment Act, creating one-stop shops for job training, the National Skills Standards Board, which established training standards in major industries, and the School-to-Work Partnership Act of 1994, designed to help students make the transition into the work force. This legislation provided $1.6 billion to states for school-to-work pilot programs. Developing AmeriCorps. After President Clinton's election, Mrs. Clinton worked closely with her staff to develop the national service initiative that would become AmeriCorps. She argued forcefully that the national service bill should be crafted in order to allow young people of all backgrounds to participate and that the program include assurances of child care and health care benefits for AmeriCorps volunteers. She helped shepherd the legislation through Congress, playing an important behind-the-scenes role. After the legislation was signed into law in September 1993, she monitored its implementation, ensured that it received continued White House attention, and continued to appear at eyents that would raise the program's visibility. In 1999, she encouraged the planning of a fifth anniversary celebration of AmeriCorps and helped launch an effort to endow City Year, a flagship national service program. Her domestic policy council staff at the White House is currently handling the AmeriCorps reauthorization legislation. Street Fighting youth violence. Mrs. Clinton proved to be an early, influential voice concerned about youth violence and its impact on our nation's schools and communities. In August 1994 she addressed the National Conference on Youth Violence, speaking about the "culture of violence" facing youth in the media and on the streets. In 1998 and 1999, she took numerous steps to combat youth violence, including hosting a White House Conference on School Safety, writing three nationally syndicated columns on the topic, and speaking at more than a dozen events relating to youth violence. Following the Columbine High School shootings, Mrs. Clinton met with victims' families, hosted a strategy session at the White House on Children, Violence, and Responsibility, and stepped up her long-standing efforts to promote handgun control. Mrs. Clinton also worked with the President to launch the National Campaign Against Youth Violence, a non-profit organization dedicated to working with local communities to prevent youth violence. The First Lady was an early supporter of the Million Mom March and joined the thousands of women who marched on the National Mall this year to call for sensible gun safety laws. Reducing teen pregnancy. Mrs. Clinton has also focused her efforts on preventing teen pregnancies. In 1997, she urged the creation of a bipartisan Campaign for the Prevention of Teen Pregnancy, hosted its first honors ceremony in the East Room of the White House, and participated in several key events to build support for the effort. She urged groups involved in the issue to look beyond ideological lines, helping unite liberal and conservative organizations in their common mission to reduce teen pregnancies. These efforts to promote abstinence and personal responsibility have provided more teens with mentors and access to college and jobs, and have fostered local prevention strategies targeted to both girls and boys. With the strength of 2 Mrs. Clinton's leadership, a third of all U.S. communities now have HHS-funded teen pregnancy prevention activities - exceeding the goal of 25 percent set in the 1996 welfare reform law. All told, Administration efforts pushed the rate of teen pregnancy to a record low in 1998, with a particularly large drop in births to African-American girls. This year, Mrs. Clinton has continued her efforts to provide more opportunities to teen parents. She has been a vocal advocate for the Administration's proposal to support second-chance homes, an innovative approach to help teen parents who cannot live at home. These adult-supervised living arrangements offer parenting skills, job counseling, education and other referrals that help reduce repeat pregnancies and improve the prospects for young mothers and their children. Transition from foster care. Mrs. Clinton's longstanding work on behalf of children in foster care led her to focus on youth who are forced to leave foster care when they turn 18, often with limited supports to help them make the transition to independence. Few of these youth go on to college and a significant number become homeless after they lose benefits they had received while in foster care. Groundbreaking legislation developed by Mrs. Clinton and her staff and signed into law in 1999 now allows these young people to remain on Medicaid until the age of 21, and gives them extra help in finishing high school, going to college, and finding work and a place to live. Promoting afterschool care. The First Lady has also been a leader within the Administration in support of afterschool care. Knowing that high-quality afterschool programs can both lower risk behaviors and increase school success, she pushed for funding for the 21st Century Community Learning Center program and has visited numerous afterschool programs around the country. Funding for afterschool has provided nearly 850,000 children with after school opportunities. Youth philanthropy. Mrs. Clinton, who led the planning of the White House Conference on Philanthropy in 1999, worked to ensure that the gathering included a focus on teaching young people the giving tradition. As a result of the conference, a group of foundations is now working to create a national initiative that will give young people of all backgrounds the opportunity to contribute to funds in their own communities, and to make decisions about which local organizations will receive these resources. Raising healthy teens. Most recently, out of growing concern for the many challenges facing today's teens and their parents, Mrs. Clinton planned and implemented the May 2000 White House Conference on Teenagers. This historic event brought together parents, teens, policy makers and other experts to discuss the importance of the teenage years in the social and intellectual development of children. Like the White House Conference on Early Learning and Childhood Development in 1997, the teen gathering underscored some of the common misconceptions that parents have about the teenage years and offered strategies for raising responsible and resourceful youth. Initiatives that emerged from the conference included a "Time with Teens Campaign," a public awareness campaign about the importance of adult-teen interaction; a website to provide teenagers with information available through the federal government - americasteens.gov; a focus on improving media resources for teenagers and their parents; and a call for more afterschool and community service opportunities for teenagers. Clinton Presidential Records Digital Records Marker This is not a presidential record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff. This marker identifies the place of a tabbed divider. Given our digitization capabilities, we are sometimes unable to adequately scan such dividers. The title from the original document is indicated below. Healthcare Divider Title: THE IMPACT OF THE HEALTH SECURITY ACT ON SUBSEQUENT HEALTH CARE ACHIEVEMENTS I. REFORMING THE INSURANCE MARKET / ASSURING PATIENT PROTECTIONS The Health Security Act had numerous provisions to reform the insurance market and assure consumer protections. These included protections against discriminatory underwriting practices, patient and medical records privacy protections, steps towards mental health parity, and provisions to streamline the duplicative and burdensome red tape associated with insurance and provider claim forms. Accomplishments include: Passage of the landmark Kennedy-Kassenbaum legislation that ensures individuals continued access to health insurance (Public Law 104-191). The Kennedy- Kassenbaum (Health Insurance Portability and Accountability Act) legislation prevents individuals from being denied coverage because they have a preexisting medical condition. It requires insurance companies to sell coverage to small employer groups and to individuals who lose group coverage without regard to their health risk status. It also prohibits discrimination in enrollment and premiums against employees and their dependents based on health status. Finally, it requires insurers to renew the policies they sell to groups and individuals. Passage of legislation requiring mental health parity for annual and lifetime insurance limits (Public Law 104-204). Passage of legislation to eliminate duplicative and wasteful administrative requirements of the health care system (Public Law 104-191). Issued landmark Federal regulations protecting the privacy of electronic medical records. Passage of legislation prohibiting discriminatory underwriting practices by insurers through the use of genetic information (Public Law 104-191). Issued executive memorandum requiring that the 85 million Americans in Federal health plans receive critical patient protections. Endorsed the bipartisan Norwood-Dingell Patients' Bill of Rights and worked for its passage. This legislation, endorsed by over 200 health care advocacy groups, is the only proposal that meets the Administration's fundamental criteria: that patient protections be real and that court enforced remedies be accessible and meaningful. The legislation includes: guaranteed access to needed health care specialists; access to emergency room services when and where the need arises; continuity of care protections; access to a fair, unbiased and timely internal and independent external appeals process; and an enforcement mechanism that ensures recourse for patients who have been harmed as a result of health plan's actions. Issued executive order preventing genetic discrimination in Federal hiring and promotion actions. Endorsed legislation to prohibit unauthorized use of genetic information by health insurers and employers. II. EXPANDING COVERAGE The Health Security Act was designed to ensure that every American had affordable, quality, health insurance. Subsequent achievements and proposals by the Clinton Administration provide targeted coverage expansions. Since 1995, the President has enacted the Children's Health Insurance Program, the Work Incentives Improvement Act, and the Foster Care Independence Act. In addition, he has proposed several major health care expansions that would represent the largest investment in health insurance coverage since the enactment of Medicare. Accomplishments include: Enacted single largest investment in children's health care since 1965 (Public Law 105-33). The Balanced Budget Act included $48 billion for the State Children's Health Insurance Program - the single largest investment in health care for children since the enactment of Medicaid in 1965. This new program, together with Medicaid, will provide meaningful health care coverage for up to five million previously uninsured children - including prescription drugs, vision, hearing, and mental health services. Within three years of enactment, all 50 states have implemented S-CHIP programs, and over 2 million children have been covered. In addition, the number of states covering children up to 200 percent of poverty increased by more than 7 fold - to 30 states - during that time. Enacted landmark legislation providing new health insurance opportunities for working people with disabilities (Public Law 106-70). The Jeffords-Kennedy Work Incentives Improvement Act creates important new health insurance options provided to people with disabilities. Enacted new legislation to help young people leaving foster care (Public Law 106-169). Approved waivers expanding health insurance coverage for Americans. Issued Executive Directives to target and enroll uninsured children and launched the national Insure Kids Now Campaign. Proposed $110 billion in FY 2001 budget to extend coverage to over 5 million currently uninsured Americans and provide more affordable coverage to millions more. Invested $220 million in the FY 2001 budget for Medicaid coverage of certain uninsured women with breast and cervical cancer. 2 III. ELIMINATING TAX INEQUITIES IN HEALTH CARE The Health Security Act included a number of provisions to eliminate tax inequities in health care, including limiting the exclusion for employer provided health benefits, increasing the deduction for self-employed workers, and providing tax breaks on long-term care insurance premiums. Accomplishments include: Enacted legislation to eliminate the discriminatory tax treatment of the self- employed (Public Laws 104-191 and 105-33). Enacted legislation to provide consumer protections and tax incentives for private long- term care insurance (Public Law 104-191). IV. STRENGTHENING AND MODERNIZING MEDICARE The Health Security Act would have made a significant contribution to extending the life of the Medicare Trust Fund through a series of improvements and program efficiencies, as well as added a new Medicare prescription drug benefit. Accomplishments include: Enacted Medicare reforms that extended solvency, provided new preventive benefits, and added new plan choices (Public Laws 105-33 and PL 103-66). Enacted legislation and took administrative action to fight fraud and waste in Medicare (Public Law 104-191). Enacted legislation to help remedy the reimbursement concerns of health care providers (Public Law 106-113). Issued an Executive Memorandum directing Medicare to reimburse providers for the cost of routine patient care associated with participation in clinical trials. Proposed new, comprehensive plan to strengthen and modernize Medicare for the 21st century. This historic initiative would: Make Medicare more competitive and efficient, Modernize Medicare's benefits, including a long overdue prescription drug benefit, strengthening Medicare's financing for the 21st century. V. PROTECTING MEDICAID AND IMPROVING LONG-TERM CARE The Health Security Act ensured that Medicaid beneficiaries received the same stable, high quality health care coverage as other Americans. It also assured that former Medicaid beneficiaries continued to receive all additional specialized services that they received under Medicaid. The Act 3 provided for a new program to deliver home and community based care, as well as tax incentives for quality long-term care insurance. Vetoed Republican proposals to block grant Medicaid, which threatened insurance coverage for millions of low-income people and nursing home residents. Enacted new actions to modernize the Medicaid program in the Balanced Budget Act of 1997. (Public Law 105-33). Launched a comprehensive nursing home quality initiative. Approved state waivers to help seniors and individuals with disabilities to stay in their communities. Proposed new assistance for individuals with long-term care needs and their caregivers. VI. PUBLIC HEALTH The Health Security Act included major developments in public health, including significant new investments in biomedical and behavioral research related to health promotion and prevention of disease and health services research. In addition, the Act provided grants to states for core public health functions, a focus on health care for the traditionally underserved, and support for health care professionals and institutions that work in this area. Enacted unprecedented investments in biomedical research. Enacted historic investments in reproductive health. Enacted new investments in mental health prevention and treatment. Enacted funding increases for AIDS research, prevention, housing, and treatment. Held the first ever White House Conference on Mental Health. Released the landmark Surgeon General's report on mental health. Launched new effort to increase childhood immunizations. Launched new effort to eliminate racial health disparities 4 Q. Wouldn't the Health Security Act have hurt New York? A. No. At the time, we estimated that New York would be one of the big winners under the plan. Given the large number of uninsured in the State, New York would have received for this year $9 billion for premiums for the uninsured in the year 2000. The state would also have gotten $1.5 billion from the new long-term care program that we proposed. Moreover, we now know that our proposed spending in Medicare would have been $100 billion higher for 1996 through 2000 than it actually has been. Overall, a recent analysis showed that overall Medicare and Medicaid spending has been about half a trillion lower over the past 5 years than we projected at the start of the Administration. That would have been more than enough to have invested in helping the uninsured, improving long- term care and providing an affordable prescription drug benefit. In contrast, Rick Lazio supported the Contract with America's $270 billion cut to Medicare and its block grant of Medicaid that would have left nearly a million children, seniors and people with disabilities in New York uninsured. THE WHITE HOUSE Office of Media Affairs September 14, 1995 Contact: 202/456-7150 NEW YORK The Republican Budget Resolution Conference Agreement: Medicaid Cuts Will Force States to Reduce Health Coverage Republicanus Proposal: Reduces Medicaid Payments to States by 30% in 2002 Republicans are proposing to cut more than $182 billion from Federal Medicaid spending between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. New York would lose $19 billion over the seven years, a 27% reduction in 2002 alone. Even if New York could absorb half of the cuts by reducing services and provider payments, it would still have to eliminate coverage for 645,000 people in 2002, according to the Urban Institute, including: 0 66,400 older Americans; 0 100,400 people with disabilities; and 0 478,200 children and their families. The Republican proposal would force New York to eliminate coverage for about 71,300 people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care for all Americans, including the middle class. Currently, Medicaid covers 79% of the 84,500 nursing home residents in New York. Medicaid also serves about 241,800 older Americans and people with disabilities using home care in New York. Without Medicaid, families of the elderly and disabled could not afford nursing home care that costs an average of $38,000 per year nationally. The Republican proposal would force New York to eliminate coverage for 343,700 children in 2002. * Currently, 25% of the children in New York rely on Medicaid for their basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of emergencies for about 1,300,000 children in New York. New York could avoid these difficult choices forced by the Republican proposal only by increasing its Medicaid spending by 27% in 2002 -- by raising property or sales taxes, or cutting other critical state spending. The President's Balanced Budget Proposal The Presidentus proposal saves $54 billion over seven years from Medicaid, less than one- third the Republican cut and still a significant contribution toward deficit reduction. The Presidentus Medicaid policy produces savings by reducing and retargetting disproportionate share payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending per recipient. This policy constrains Federal spending but allows states to respond to unexpected changes in the number of people covered. It does not put states at risk and dismantle a program that has served as a critical safety net -- as would happen under the Republican proposal. * U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding. IMPACT OF HEALTH SECURITY ACT ON NEW YORK HOSPITALS The Following New York Hospital Data Shows Two Essential Points: Even with the reductions in Medicare and Medicaid growth rates, New York hospital revenues under HSA steadily increase To maintain their historical profits under reform, hospital costs could grow at 3.2%. This level assumes some productivity improvements, but is within historical levels. (Between 1969-1991, hospital costs increased at 3.6%/year) Productivity improvements are possible and can be achieved in at least three areas: 1) administrative savings; 2) savings on their own health care benefits to their employees; and 3) better integrated care. BENEFITS FOR NEW YORK STATE HOSPITALS DRAFT NEW YORK STATE HOSPITALS UNDER THE HEALTH SECURITY ACT ALL HOSPITALS TEACHING HOSPITALS PATIENT CARE 2.5% 4.3% MARGINS TODAY BASELINE GROWTH IN 9.3% 9.3% HOSPITAL COSTS * COST GROWTH 6.6% 6.6% UNDER REFORM REAL COST GROWTH 3.2% 3.2% UNDER REFORM * Assumption from Health Care Association of New York State DRAFT HOSPITAL REVENUES, NEW YORK STATE, ALL HOSPITALS, BEFORE AND AFTER THE HEALTH SECURITY ACT, BILLIONS OF DOLLARS 1993 1994 1995 1996 1997 1998 1999 2000 TOTAL $25.1 $27.3 $29.8 $32.5 $35.2 $37.7 $40.0 $42.2 MEDICARE $8.2 $8.9 $9.7 $9.9 $9.8 $10.7 $11.6 $12.5 MEDICAID $5.9 $6.5 $7.1 $7.6 $9.2 $9.7 $10.2 $10.7 PRIVATE $9.4 $10.3 $11.2 $12.3 $11.6 $12.1 $12.6 $13.1 PREVIOUSLY $1.6 $1.6 $1.8 $2.0 $4.0 $4.2 $4.3 $4.5 UNINSURED ACADEMIC $0.5 $0.6 $0.9 $1.2 $1.2 POOLS — - - VPA $0.2 $0.2 $0.2 $0.2 $0.2 - - — * Assumption from Health Care Association of New York State DRAFT HOSPITAL REVENUES, NEW YORK STATE TEACHING HOSPITALS, BEFORE AND AFTER THE HEALTH SECURITY ACT, BILLIONS OF DOLLARS 1993 1994 1995 1996 1997 1998 1999 2000 TOTAL $20.7 $22.5 $24.6 $26.9 $29.1 $31.1 $33.0 $34.8 MEDICARE $6.5 $7.0 $7.6 $7.5 $7.6 $8.2 $8.8 $9.5 MEDICAID $5.4 $5.9 $6.5 $7.1 $8.4 $8.9 $9.3 $9.8 PRIVATE $7.3 $8.0 $8.7 $9.5 $8.9 $9.3 $9.7 $10.1 PREVIOUSLY $1.6 $1.6 $1.8 $2.0 $3.5 $3.7 $3.9 $4.0 UNINSURED ACADEMIC $0.5 $0.6 $0.9 $1.2 $1.2 POOLS - - - VPA $0.1 $0.1 $0.1 $0.1 $0.1 — — - * Assumption from Health Care Association of New York State Hc tal Revenues, NO York State Hosp als Before and After the Health Security Act $50.0 $42.2 $40.0 $40.0 $37.7 $35.2 $32.5 $29.8 Dollars in Billions $30.0 $27.3 $25.1 $23.1 $20.0 $10.0 $0.0 1992 1993 1994 1995 1996 1997 1998 1999 2000 <---Before the Health Security Act---> <-With the Health Security Act-> Hospital Revenues, New Yurk State Teaching Hospitals Before and After the Health Security Act $40.0 $34.8 $35.0 $33.0 $31.1 $30.0 $29.1 $26.9 $24.6 $25.0 Dollars in Billions $22.5 $20.7 $20.0 $19.1 $15.0 $10.0 $5.0 $0.0 1992 1993 1994 1995 1996 1997 1998 1999 2000 <---Before the Health Security Act---> <-With the Health Security Act-> Pe nt Increase in Rea Costs, New York Spe Hospitals Before and After the HSA 4% 3.6% 3.2% 3% 2% 1% 0% 1969-1991 With the HSA P ent Increase in Re Costs, New York Late Hospitals Before and After the HSA ) 6% 5.3% 5% 4% 3.7% 3.3% 3.2% 3% 2% 1.5% 1% 0% 1969-77 1978-82 1983-85 1986-91 With the HSA ORIGINAL RATE NYC FISCAL NYPHRM/ALL- MEDICARE ON PPS SETTING SYSTEM CRISIS ERA PAYER RATE- NEW YORK STATE SAVINGS UNDER HEALTH SECURITY ACT New York State will save $8.6 billion in public health care spending between 1996 and 2000. CHANGE IN SPENDING UNDER HEALTH SECURITY ACT $BB 1996 1997 1998 1999 2000 TOTAL (1996-2000) Acute Care Medicaid NA 0.5 (1.3) (2.5) (3.3) (6.6) LTC Savings (0.2) (0.3) (0.4) (0.5) (0.6) (2.0) State employee health NA NA NA NA (0.07) (0.07) care spending TOTAL PUBLIC (0.2) 0,2 (1.7) (3.0) (4.0) (8.6) SAVINGS * In addition, the private sector will save $4.9 billion in lower premiums in FY 2000 alone. (Earlier years are not available.) THE WHITE HOUSE WASHINGTON MEMORANDUM TO FIRST LADY HILLARY RODHAM CLINTON From: John Hart, Deputy Assistant to the President for Intergovernmental Affairs Date: April 14, 1994 Subject: New York Health Care Overview I. Overview For years New York State has shouldered the burden of a growing uninsured population, increasing health care costs, the rising expense of health care coverage for its own employees, and increasing reliance on expensive emergency room care. Recent reforms in New York attempt to contain the costs of health care through managed care, and increased attention to primary and preventive care services. New York's new community rating law sets a national standard for expanding access to coverage and returning insurance to what it was meant to be. But in the absence of national reform, none of these efforts will produce lasting savings or true universal coverage. Like the recent reforms in New York State, the Health Security Act seeks to incur savings by encouraging primary and preventive care, and discouraging unnecessary and expensive hospital stays. While New York's legislation limits costs through a rate setting system for hospitals, the Clinton legislation uses premium limits, managed competition, public evaluation data, and bidding mechanisms to contain costs. New York State will benefit from the plan's commitment to cost containment, new investments in public health, malpractice reform, expanded access to doctors, clinics and hospitals for all New Yorkers, special long-term care provisions for the elderly and disabled, and administrative simplification in the system. Most importantly, the Clinton plan will enable New York State to develop a health care system that reflects the needs of its diverse population -- from the residents of Manhattan's 12 health crisis zones to the underserved residents of rural upstate. The Clinton health plan proposes national reform based on a new partnership between states and the federal government -- a partnership that ensures that every local resident will have health care coverage, that rising health care costs will be controlled, and that every state will have the flexibility to address their critical health needs. II. Issues of Concern in New York State In February, Governor Cuomo presented the findings of his own task force on the Clinton plan. While the Cuomo administration "supports Clinton's goals, there is a disagreement on how to get there." The following are the major concerns expressed by the task force. A. Medicaid Formula Senator Moynihan and Governor Cuomo have been vociferous opponents of the current Medicaid match system, claiming it is an inequitable arrangement for New York. Response - The administration agrees with New York, the Urban Institute and the GAO on the unfairness of the current formula. The Health Security Act establishes a Medicaid Equity Commission for the express purpose of addressing the Medicaid equity issues raised by Senator Moynihan and Governor Cuomo. The commission is designed along the lines of the military base closure commission and would study and design new measures to be incorporated into a revised match rate formula. It is important to note that New York benefits from the current match rate formula. Presently, federal matching rates are based solely on state per capita income, but must be between a floor of 50% and ceiling of 83%. New York is one of 13 higher income jurisdictions that benefitted from the 50% floor in FY 1993. In sum, a strict application of the current formula in New York would have resulted in New York receiving less than a 50% federal match. The match rate formula is not the primary cause of New York's high Medicaid costs. New York provides almost all of the optional Medicaid services and does so on a much larger scale than other states. For example, in FY 1992, New York accounted for almost a third of all Medicaid spending on home health services, and over two thirds of all Medicaid spending on personal care services. New York has also expresses concern that its "extensive investments" in community based long-term care penalize the state in regards to the match rates. New York's investment in community based long term care are not relevant to the match rate. The match measures the capacity to pay. The Health Security Act's increased financing of home based care will provide substantial fiscal relief to New York state. B. Undocumented Residents It is estimated that 15% of the nation's illegal aliens reside in New York state, which places a considerable burden on state health care resources. Response - No one in America is turned away from any hospital. In order to ensure that the population as a whole remains healthy, it is necessary for all residents to have access to health care. Undocumented residents will not be eligible for inclusion in the Health Security Act, because eligibility is limited to citizens and legal residents. Undocumented residents will continue to receive care through community health centers, migrant health centers, and emergency room care bolstered by continued federal funding. To pay for these services, Medicaid Disproportionate Share payments (DSH) will be converted into the Vulnerable Population Adjustment program (VPA) for providers with large numbers of patients who are poor or are not American citizens. Children that are born in the United States to undocumented mothers are automatically citizens, and will be covered under the plan. The undocumented mother will continue to receive care, funded through the VPA program. C. Coverage of Mental Health and Substance Abuse New York state is concerned that the Health Security Act will be less comprehensive than existing Medicaid substance abuse and mental health coverage. Response - The Health Security Act takes serious steps to cover a broad range of treatment options and by eliminating pre-existing condition exclusions and lifetime limits that today restrict the access of individuals with mental or substance abuse disorders to needed services. The benefit package gradually expands coverage for mental illness and substance abuse for both inpatient and outpatient therapy. Coverage includes inpatient and residential treatment; intensive nonresidential treatment; and outpatient treatment including screening and assessment, diagnosis, medical management, collateral services, psychotherapy and crisis services. Initially, the benefit package contains limits on the number of days for some services, but it commits to removing those limits by the year 2001. Through universal coverage, larger numbers of individuals with severe disorders will obtain access to services. It is important to note that while the state worries about reduced coverage under the HSA, the New York Legislature agreed in November to close five state mental hospitals and reduce the number of beds by 2,400 while increasing existing funding for outpatient care in order to save an estimated $210 million over 5 years. D. Long-Term Care New York state is concerned that under the Health Security Act, the requirement of states to contribute 5-25% of long term care costs would further burden states that are already burdened by Medicaid costs. New York would pay the maximum, 25% of the share for long term care. Response - Since Medicaid recipients of home health care would be transferred to the long term care program, there would be a resulting net gain in federal money even as more people be served. The Health Security Act will expand and improve long-term care options across the country, stressing home and community based services. The plan will aim to provide more flexibility and greater flexibility for older Americans and Americans with disabilities who need support. Under the Health Security Act, New York will have the necessary flexibility to organize and design its long-term care program within a supportive national framework. E. Private and Public Employer Inequities New York is concerned that while other employers have a 7.9% cap on the percent of payroll, this does not apply to public employees. This presents a problem to the state where health benefits currently account for 9.7% of payroll. Response - It is important to note that public employees will receive the same cap in 2000 to limit health payments to 7.9%. Public employees are not responsible for paying the 1% of payroll corporate alliance assessment. Since New York operates one of the largest and most successful purchasing cooperatives (NYSHIP) for over 400,000 state and local government employees and 700,000 of their dependents, this exclusion would help to lower costs. While NYSHIP offers more comprehensive benefits than the uniform benefits package, it is important to note that the Health Security Act allows public employers to offer any supplemental benefits to its employees. Public employers benefit immediately upon implementation from the stability of community ratings. Public employers will see immediate fiscal relief from federally-financed coverage of early retirees. III. Fiscal Benefits of the Health Security Act to New York State Our plan will provide substantial relief for New York State. The Administration has been working with New York in an effort to satisfy New York's concerns. HHS has estimated that once we place a cap on the rate of growth of Medicaid (currently 15% in New York), increase funding for home and community based long term care (currently shared by New York), provide a better environment for managed care (New York currently has one of the lowest rates of utilization in the country), and provide coverage for the uninsured, New York state will save at least $8.6 billion dollars. New York will save at least $8.6 billion between 1996 and 2000 in its Medicaid community-based long-term care expenditures, and its employee health benefits expenditures. New York will save an estimated $9.2 billion in state Medicaid expenditures between 1997 and 2000. New York will save an estimated $2.0 billion in state Medicaid and state-only expenditures for community- based long-term care between 1996 and 2000. New York will receive an estimated increase of $2.8 billion in federal expenditures for community-based long-term care between 1996 and 2000. Employers in New York that currently offer insurance will pay an estimated $3.7 billion less in premiums in the year 2000 than they would without comprehensive reform. Workers in New York that currently receive insurance from their employer will pay an estimated $1.2 billion less in premium payments in the year 2000 than they would without comprehensive reform. New York residents and businesses will receive an estimated $5.4 billion in federal funds for discounts for premium and out-of-pocket payments in the year 2000 under the Health Security Act. IV. Benefits to New York under the Health Security Act The Health Security Act will build upon New York's reforms to ensure that all New Yorkers will receive universal coverage within a system that is flexible enough to meet the diverse needs of New York State. New York will benefit financially from the cost savings and universal coverage at the core of the President's plan. A. Medicaid New York will realize immediate Medicaid savings from the setting of per capita payments to alliances on behalf of AFDC and SSI recipients at 95 percent of current fee-for-service levels. New York will achieve ongoing savings because its payments to alliances will be capped at a budgeted rate of growth, in contrast to New York's most recent rate of 15%. The new Medicare drug program will reduce New York's spending on drugs for the low-income elderly. B. Uninsured and Underinsured 12.3% of New York's population is uninsured. 14.2% of the population is underserved. The Health Security Act will provide coverage for these individuals, so that all legal residents will be covered whenever and wherever they need medical services. Federal discounts will cover premium payments for low- income people, who will enroll in a health plan through their regional health alliance. As a result, New York's payments for uncompensated care -- including direct spending to public hospitals and clinics -- will be dramatically reduced with a system of universal coverage. Often Medicaid recipients as well as the uninsured access the most costly health care available: emergency room care, which is ultimately paid for with state and county funds. By encouraging preventive and primary care, the Health Security Act will drastically reduce the frequency of costly emergency room visits. C. State Employees A new cap on employers' expenditures on employees' health care will limit New York's rapidly increasing cost for covering their employees. As of the year 2002, New York governments' costs for providing insurance to government employees will be capped at 7.9% of total payroll. Federal subsidies for early retirees will produce large savings for New York State employee health benefit programs. D. Rural and Underserved Areas Currently 15.7% of New York State's population live in rural areas. Under the Health Security Act, New York will receive new federal grants to provide special assistance to rural and inner city areas and additional support for health care for vulnerable populations. E. Access Initiatives Enhanced federal grants will be available to support public health initiatives and remove non-financial barriers to health care. New York and its counties will be able to strengthen and improve essential public health activities including: * mental health and substance abuse services; * residential treatment centers; * and community-based ambulatory clinics in underserved areas. F. Information Infrastructure Surveys and data collection similar to those recently proposed in New York State will be adopted establishing clear and useful data to monitor health care access and quality. States, local hospitals, and doctors have historically provided care in needy communities, in spite of economic difficulties. Currently, 38 community and migrant health centers care for the underserved residents of New York State. The plan will ensure that these services continue to be provided, and that these hospitals, clinics, and doctors will thrive in the new health care system. G. Safety Net Providers Hospitals and clinics that have provided care without compensation will receive guaranteed reimbursement for the care they provide. V. New York State Statistics 16.1% of New York State's population were uninsured in 1993. Of the 1.6 million uninsured adults in New York State, 61% are employed. 48% of the uninsured work in small businesses. 20% of the uninsured, or 421,000 of New York's uninsured, are children aged 17 and under. 1,051,000 or 50% of the uninsured live in single parent households, as compared to 30% of the insured. 64% of these people, or 673,000, are female headed households. State Rank 1st -- Medicaid payments per recipient ($5,975) 4th -- Percent of population covered by Medicaid (14.0%) 5th -- Medicaid expenditures as a percent of state budget (22.6%) 11th -- Percent of population enrolled in HMOs (18.4%) 15th -- Infant mortality rate per 1000 live births (9.4) 20th -- Percent of population uninsured (16.1%) 27th -- Percent of population underserved (14.2%) Medicaid * New York State Medicaid spending has increased over 15% in the last year. * For FY 92, State Medicaid spending in New York accounted for 22.6% of the state budget, estimated at $4.6 billion. * For FY 93, State Medicaid expenditures in New York are projected at $5.2 billion. * For FY 94, State Medicaid appropriations in New York are estimated at $5.6 billion. * The FY 1992 FMAP for New York was 50. * There were 2,558,000 Medicaid recipients in 1992. February 25, 1994 MEMORANDUM FOR HILLARY RODHAM CLINTON FROM: LYNN MARGHERIO SUBJECT: NEW YORK HOSPITALS New York Hospitals In General: The attached New York hospital data show: Even with the reductions in Medicare and Medicaid growth rates, New York hospital revenues under HSA steadily increase To maintain their historical profits under reform, hospital costs could grow at 3.2%. This level assumes some productivity improvements, but is within historical levels. (Between 1969-1991, hospital costs increased at 3.6%/year) sind by Productivity improvements are possible and can be achieved in at least three areas: 1) administrative savings; 2) savings on their own health care benefits to their employees; 3) better integrated care. Kings County Hospital: Kings County is the largest of 11 acute care facilities in the Health and Hospitals Corporation. Kings County Hospital will benefit under reform in the following ways: 1) Universal coverage and blended Medicaid rate provides stable and increased funding. Kings County is dominated by uninsured and Medicaid patients. Today, the costs of the uninsured and the lower-than-cost payments by Medicaid are largely funded through a city tax levy. Under reform, the uninsured will be covered and the Medicaid rates will be spread across the alliance area. 2) Increased funds for research and teaching. Teaching hospitals get compensated in two primary ways: through Medicare GME and IME funds and through a cost shift to private payers. Kings County gets very little for these functions because: a) it has a very low Medicare patient load; b) it cannot cost shift to private payers. Under reform, the GME and the AHC pools that will be created will ensure that Kings County receives funds to pay for teaching and research. 3) Greater ability to attract physicians. Because physicians cannot bill directly for services at Kings County, the hospital has had difficulty attracting physicians to provide patient care services. As a result, they have relied heavily on lower-cost foreign medical school graduates and have had to enter into affiliation agreements with other academic medical centers to hire supervising physicians. Under reform, their patient population will be covered with private insurance and physicians will be able to bill directly for services. This should enable them to attract physicians. 4) Essential community provider provision. Health plans are required to contract with providers in medically underserved areas. 5) Increased PHS funds for outreach and network development. They will be concerned about the following points: 1) Reducing the number of residents. The Health Security Act proposes to limit the proportion of residencies to a certain percentage of U.S. medical school graduates (our bill does not give a specific percentage; both Rockefeller and Cooper propose limiting the number of residencies to 110% of U.S. medical school graduates). Kings County has a very high proportion of residents/ patients and they have a huge number of foreign medical school graduates. There are two answers to this: 1) They will be able to reduce the resident/patient ratio as they substitute physicians for residents since physicians will be able to direct bill under universal coverage. 2) They won't have to rely so heavily on expensive supervising MDs from affiliated medical centers to supervise their residents. 2) Access to capital. They need a great deal of capital improvement. To this, you can argue that the city of New York will achieve substantial savings under health reform and monies that currently pay for the uninsured and other services that will now be covered under the benefits package could be redirected toward capital improvement. (With New York's budgetary problems, this may or may not happen, however.) http://www.hhs.gov/news/press/pre1995pres/940301.ti 1994.03.01 : State-by-State Study of HSA FOR IMMEDIATE RELEASE Contact: HHS Press Office Tuesday, March 1, 1994 (202) 690-6343 HHS RELEASES STATE BY STATE STUDY OF THE HEALTH SECURITY ACT Enactment of President Clinton's Health Security Act will provide substantial financial relief to state governments, according to the results of a study released today by the U.S. Department of Health and Human Services. "States are clearly among the winners under the Health Security Act. These studies show that the combination of guaranteed private insurance, long-term care coverage and effective cost containment under the President's plan results in considerable savings to state governments as well as to American workers and businesses in these states," said Kenneth E. Thorpe, Deputy Assistant Secretary for Planning and Evaluation/Health Policy, author of the study. Savings result from three primary sources: coverage of Medicaid beneficiaries in private health plans; reduced costs to states due to the new home and community-based care benefit; and savings in state governments' costs of covering their employees. The study also examines changes in each state's private health care costs, providing estimates of savings to businesses and workers in each state. The state-by-state studies show that states will experience significant savings under the Medicaid program by enrolling beneficiaries in private health plans, where costs would increase at a slower rate. In recent years, record-high growth rates in the Medicaid program have consumed a growing portion of state budgets, taking state resources away from other priorities, such as education, fighting crime, expanding job training, and improving roads and highways. In 1993, states spent more money on health care than they did on tax-financed higher education. In the last three years, state Medicaid costs have grown from just over 8 percent of state budgets in 1990 to 12 percent in 1993, and are projected to consume nearly 18 percent of state budgets in the year 2000. States will achieve additional savings in the provision of long-term care services. The Health Security Act provides new federal funds for home and community-based care for the elderly and the disabled. States will also benefit from a reduced rate of growth in health insurance expenditures for public employees as well as the relief from the costs of early retiree health care. The Health Security Act uses competition among health care providers to help reduce the rate of growth in insurance premiums. The findings are supported by the studies completed by the private consulting firm of Lewin-VHI and the Congressional Budget Office (CBO). While neither has done individual state level analyses, both Lewin-VHI and CBO show even greater overall savings to states than are projected in the HHS study. NOTE: Copies of state impact reports are available from the HHS Press Office. 1 of 2 9/20/2000 5:55 PM FIRST LADY HILLARY RODHAM CLINTON WORKING TO ADDRESS THE SPECIAL HEALTH NEEDS OF GULF WAR VETERANS First Lady Hillary Rodham Clinton has always believed that we have a special obligation to our nation's veterans, who have made great sacrifices to keep our country safe and uphold our most cherished ideals. In recent years, drawing on her experience and expertise in health care issues, the First Lady has focused on the wide ranging health needs of Gulf War veterans. Her efforts have brought critical attention to the undiagnosed illnesses facing these veterans and have been instrumental to improving the federal response to their health care problems. OUTREACH TO AMERICA'S VETERANS In the first two years of the Administration, the President and First Lady received many heart- wrenching letters and personal appeals from Gulf War veterans and their families. Thousands of brave men and women suffered from undiagnosed and unexplained illnesses after service in the Persian Gulf War. Many of these veterans were having difficulty receiving appropriate care and felt their country had forgotten them. In many cases, doctors could not determine the cause of the illnesses or even prescribe treatments; in some instances, children of Gulf War veterans were born with birth defects or other serious illnesses. In response to the health concerns of these veterans and their families, the First Lady began to research the federal government's health programs and meet with experts and constituency groups to determine a more adequate federal response. She met with officials from the U.S. Department of Defense, the Veterans' Administration, and the Department of Health and Human Services to develop strategies to better address the serious health concerns of veterans and to facilitate research into the causes of their illnesses. Mrs. Clinton also began meeting with representatives of the American Legion and the Veterans of Foreign Wars, who shared their own frustrations in their attempts to bring federal attention to these illnesses. She also visited with individual veterans, active-duty soldiers and their families, and consulted extensively with members of Congress. Accompanied by the Secretary of Veterans Affairs and Pentagon officials, the First Lady visited Walter Reed Hospital and the Veterans Hospital in Washington, listening to stories of hard-working men and women who could no longer keep steady jobs and support their families because of severe symptoms. One veteran officer, diagnosed as 100 percent disabled, described the healthy and active life he had led before his tour in the Persian Gulf, and talked about his frustration in seeking effective treatment for his symptoms. RECOMMENDATIONS TO THE PRESIDENT After many consultations, the First Lady in February 1995 formulated what would become an early blueprint for a more comprehensive federal response to Gulf War illnesses. In a memorandum to the President, Mrs. Clinton described her discussions with officials at HHS, 1 DOD, and VA regarding the Administration's response, and detailed the concerns of veterans suffering from undiagnosed illnesses and the lack of effective treatment. While she noted that the Administration had taken initial steps to make these veterans eligible for compensation and free medical care, she also underscored the need for an open, coordinated and comprehensive federal response to the range of health problems facing Gulf War veterans. The First Lady's key recommendation to the President was the appointment of an independent, blue ribbon panel to investigate the issues raised by the undiagnosed illnesses and the concerns about treatment veterans received. In March 1995, at a speech before the VFW Annual Washington Conference, the President announced the creation of the Presidential Advisory Committee on Gulf War Veterans' Illnesses, a fully independent expert panel of our nation's best doctors, scientists, and Gulf War veterans, tasked to review and make recommendations on the federal government's efforts related to Gulf War illnesses. Based on input from the First Lady, the committee was directed to ensure that the federal government did everything possible to provide effective medical care to those who are ill, to coordinate research and other efforts to determine the causes of the undiagnosed illnesses, and to make information about these issues publicly available. The President also announced new research projects on anti-nerve gas drugs and pesticides, the possible transmission of illnesses to spouses and children, and new plans to release information about reports of detections of biological and chemical weapons. The First Lady testified at the committee's first meeting and outlined her findings based on her many meetings with veterans, federal officials, and other experts. After a series of meetings, the committee submitted its final report to the President and First Lady in January 1997. It included a slate of recommendations to ensure that Gulf War veterans received the care and benefits they deserved, that as much as possible is learned about the causes of undiagnosed Gulf War illnesses, and that steps are taken to safeguard our forces in future deployment. The recommendations led to three significant Administration initiatives, including extended eligibility for compensation to veterans with undiagnosed illnesses; the development of an integrated action plan by the Departments of Defense, Health and Human Services; and a new process to ensure that all agencies promote "Health Preparedness for and Readjustment of Veterans and Their Families After Future Deployment." Throughout this whole process, the First Lady and her staff continued their work on behalf of America's Gulf War veterans. The First Lady participated in a White House interagency task force, working with the National Security Council, the Office of Science and Technology Policy, and Cabinet Affairs, to ensure that the committee's recommendations were fully implemented. The First Lady also continued her efforts to reach out to veterans, scientists, government officials and others, and remained a strong voice for veterans' concerns in the Administration. Following the release of the committee's report, the President extended the life of the panel for an additional 10 months, to allow it to monitor the report's implementation. He also amended its charter to encompass independent oversight of the Department of Defense investigative process. And to restore public trust, in February 1998 the President appointed Warren Rudman as chair of a board created to provide independent oversight of DOD investigations into possible exposure to chemical or biological agents, and environmental and other factors that may have contributed to Gulf War illnesses. 2 DELIVERING RESULTS FOR AMERICA'S VETERANS As a result of the First Lady's strong leadership, critical attention has been focused on the concerns of Gulf War veterans, and the federal government has been more responsive to their health needs. To date, veterans have received nearly 120,000 free medical exams; toll-free help lines have been established for veterans and their families; and 143,138 disability claims have been approved. Moreover, HHS, DOD and VA have sponsored nearly 200 research projects to identify possible causes of undiagnosed illnesses, determine appropriate treatments, and develop ways to protect personnel on future deployments. The Persian Gulf War Veterans' Health Registry now includes information about ill spouses and children, including information about birth defects, miscarriages, and stillbirths. In addition, helping to reverse public distrust and increase accountability, DOD, with the CIA, has launched a review of more than 6.4 million pages of Gulf War documents, de-classifying more than 46,000 pages of material and putting it on the Internet. Through this effort, important information was discovered concerning the possible exposure of our troops to chemical agents. The DOD has now redoubled its efforts to investigate this and other possible causes for unexplained Gulf War illnesses. The First Lady and her staff have continued working to ensure that research on the possible causes of these illnesses translates into improved health care for our nation's veterans. Mrs. Clinton has also remained actively involved in efforts to improve public disclosure and to ensure veterans receive the compensation they deserve. 3