2000 State of the Union Address Background Materials: Health Care


Patientsí Bill of Rights
The President and Vice President continue to challenge the Congress to finally finish the overdue job of passing patientsí rights legislation that includes critical protections such as: guaranteed access to needed health care specialists; access to emergency room services when and where the need arises; continuity of care protections so that patients will not have an abrupt transition in care if their providers are dropped; access to a fair, unbiased and timely internal and independent external appeals process to address health plan grievances; and an enforcement mechanism that ensures recourse for patients who have been harmed as a result of a health planís actions. Last fall, over 60 Republicans joined virtually every Democrat in the House in voting for the Norwood-Dingell Patients Bill of Rights. This strong, enforceable, patient protections bill should not be watered down in a manner that makes it ineffective and unworthy of signing. It should also not include provisions that do little more than further segment healthy from unhealthy populations without significantly expanding coverage for the currently uninsured.

Health Insurance Coverage Initiative
The President and Vice President strongly believe we should expand access to affordable health care coverage to more Americans. The budget proposes a 10-year, $110 billion initiative that would expand coverage to at least 5 million uninsured Americans and expand access to millions more. It addresses the nationís coverage challenges by building on and complementing current private and public programs. Specifically, the initiative: (1) provides a new, affordable health insurance option for families called ďFamilyCare,Ē which builds on the State Childrenís Health Insurance Program to provide higher Federal matching payments to parents of children eligible for or enrolled in Medicaid or S-CHIP; (2) accelerates enrollment of uninsured children eligible for Medicaid and S-CHIP; (3) expands health insurance options for Americans facing unique barriers to coverage, including a Medicare buy-in with a new 25 percent tax credit; a new 25 percent tax credit for COBRA continuation coverage; an initiative to help small businesses afford insurance, and new Medicaid options for vulnerable groups of Americans (people ages 19 and 20; people leaving welfare for work; legal immigrants); and (4) strengthens programs that provide health care directly to the uninsured. If enacted, this would be the largest investment in coverage since Medicare was created in 1965.

Strengthening and Modernizing Medicare
The Presidentís budget includes a comprehensive plan to reform and modernize Medicare. This plan will: (1) make the program more efficient and competitive; (2) extend the solvency of the Health Insurance (HI) trust fund to at least 2025; (3) modernize benefits including adding a long-overdue, voluntary prescription drug benefit; and (4) create a reserve fund to be used for debt relief or to create bipartisan consensus to further strengthen the proposed drug benefit for Medicare beneficiaries. Building on the Presidentís successful fight against fraud and waste, the plan would dedicate over $300 billion in savings and surplus over 10 years to the HI trust fund, helping to meet the inevitable financing and health challenges that result from the aging of the baby boom. The proposed prescription drug benefit would be voluntary, available and affordable to all beneficiaries, including low-income beneficiaries who would pay low to no costs for coverage. It would be administered by private organizations like pharmaceutical benefit managers (PBMs) and would give financial incentives to employers who currently offer retiree prescription drug benefits to maintain coverage. Finally, a reserve fund would be created for debt reduction or, if there is bipartisan consensus, to strengthen the Administrationís drug benefit by adding protections against the cost of catastrophic drug expenses.

Long-Term Care Initiative
The budget proposes a 10-year, $28 billion initiative that helps address the nationís multifaceted long-term care challenge. It includes: (1) a $3,000 tax credit to compensate people with long-term care needs or their caregivers for the cost of care; (2) a major new investment in the Older Americans Act for information and referral as well as direct support services for family caregivers; (3) a new Medicaid option to increase income eligibility levels for home and community based services to the same levels as nursing home residents; (4) a Housing and Urban Development program to encourage assisted living facilities for low-income elderly; and (5) a new option for Federal employees to purchase quality private long-term care insurance. The FY 2001 budget also includes an additional $16.8 million to help states strengthen nursing home enforcement tools and increase Federal oversight of nursing home quality and safety standards.

Increasing Federal Support for Improving the Mental Health of All Americans
According to the December 1999 Surgeon Generalís Report on Mental Health, one in five Americans is living with a mental health disorder. This report states that the fundamental components of effective service delivery are broadly agreed upon, but in short supply. The President will highlight his new investment of $100 million for mental health services, an increase of 16 percent over last yearís funding level and a 90 percent increase since 1993.

Major New Investment to Combat HIV and AIDS in the United States
The President has proposed to invest an additional $125 million in the Ryan White Program, an increase of almost 8 percent over last yearís funding level, to provide primary medical care, pharmaceuticals critical to treatment, and other critical support services for people living with HIV and AIDS. The budget also includes an additional $50 million for HIV prevention, the largest increase ever in funding for these activities, to encourage individuals at risk to avoid behaviors that can result in the transmission of the disease.

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