STATE OF THE UNION I: Clinton Outlines Bold Health Measures
Amidst what was referred to as a "surreal atmosphere" given the ongoing Senate impeachment trial, President Clinton delivered a lengthy State of the Union address last night, outlining a bevy of new domestic health care policy priorities (Russert, NBC, 1/19). As expected, the president devoted the first part of his speech to the "aging of America," which included policy proposals on Social Security, Medicare, a new pension initiative and long term care. On Medicare, Clinton proposed using one-sixth of the budget surplus for the next 15 years to keep Medicare solvent until 2020. He called for Congress' support to "secure Medicare for the next two decades and cover seniors' greatest need -- affordable prescription drugs" (speech text, 1/19). The Wall Street Journal reports that the influx of funding would amount to $650 billion to $700 billion over the 15-year period. Administration officials also said the prescription drug benefit could be added without damaging the program's solvency by "holding down payments to providers and requiring competitive bidding by HMOs." The Journal notes, however, that the changes are likely to be fiercely opposed by the managed care lobby (Cummings, 1/20). With respect to long term care, Clinton formally announced his commitment to greater federal support, including a $1,000 tax credit for long term care patients and their families. He said, "Long term care will become a bigger and bigger challenge with the aging of America, and we must do more to help our families deal with it." Emphasizing that he is part of the baby boom generation, he added, "I can tell you that one of the greatest concerns of our generation is our absolute determination not to let our growing old place an intolerable burden on our children and their ability to raise our grandchildren. Our economic success and our fiscal discipline now give us an opportunity to lift that burden from their shoulders, and we should take it."
Health Care Hodgepodge
The president also stressed several other health care initiatives. Among them:
- Touting the Family and Medical Leave Act as "the very first bill I signed into law," he asked Congress to extend it "to 10 million more Americans working for smaller companies."
- He again called for passage of the Patients' Bill of Rights, including provisions ensuring continuity of care, the right to see a specialist and the right to immediate emergency care. He said, "Now, I've ordered these rights to be extended to the 85 millon Americans served by Medicare, Medicaid, and other federal health programs. But only Congress can pass a patients' bill of rights for all Americans. Now, last year, Congress missed that opportunity and we must not miss that opportunity again."
- He expressed concern over the threats to the privacy of electronic medical records, saying, "Congress has given me the authority to act if it does not do so by August, one way or another, we can all say to the American people, we will protect the privacy of medical records and we will do it this year."
- He rehashed his plan to allow those aged 55 and older to buy in to Medicare.
- He called for unrestricted access to family planning.
- He asked Congress "to join hands to pass the landmark bipartisan legislation -- proposed by Senators Kennedy and Jeffords, Roth and Moynihan -- to allow people with disabilities to keep their health insurance when they go to work."
- Thanking Tipper Gore for her efforts on mental health, he said the White House will host a conference on mental health this year.
- The president also announced that the Justice Department will sue the tobacco industry to recover federal funds spent treating sick smokers through the Medicaid and Medicare programs (see related story) (speech text, 1/19).
ReaxReaction to the president's health care initiatives was both immediate and varied. Some samples:
- Baltimore Sun's Jack Germond: "Clinton's proposals did not deal with many of the touchy questions that have to be resolved before Social Security or Medicare can be finally reformed. What changes, if any, are going to be required in the retirement age? What changes, if any, are going to be made in the Medicare payments to hospitals and doctors?" (1/20).
- Washington Post: "The policy was best on the structural issue of what should be done with the budget surplus. Insofar as possible, it should remain within the public sector; that is the position the president has now laid out, as he had not before. We think he's right. The surplus is illusory in the sense that, in the long term, the foreseeable claims against the government are greater than the revenues to satisfy them" (1/20).
- New York Times: The speech's "centerpiece, a vast scheme to set aside $2.7 trillion over the next 15 years to strengthen Social Security, and $650 billion more for Medicare, served notice that the president's battle to stay in office would include efforts to revitalize the big safety-net programs that are extremely popular among the swing voters whose support he needs in the impeachment fight" (1/20).
- Roll Call's Mort Kondracke: "It reminded me of Lyndon Johnson. Lyndon Johnson used to get up and regale his audiences with program after program after program. I thought that this was the era of small government, Clinton said that a couple of States of the Union ago. You couldn't see it in this speech" (Fox News Channel, 1/19).
- Sen. James Jeffords (R-VT): "It was fantastic; he has absolutely no conscience when it comes to spending money" (Hosler, Balti more Sun, 1/20).
- HIAA's Chip Kahn: "It's too bad that the president spent so much time talking about so-called patient protections ... that would benefit lawyers and health care providers at the expense of consumers. Instead, he should concentrate on the single most important domestic issue facing the nation -- the plight of Americans who lack health insurance" (release, 1/19).
- AAHP's Karen Ignagni: "Seeking solutions through micromanagement and heavy-handed mandates will not result in a better health care system for America's working families and small businesses" (release, 1/20).
- American Health Care Association: The AHCA "applauds the president's initiative, especially the proposed allocation of $10 million to educate Americans on the looming crisis we face in this country regarding long term care financing (release, 1/10).
The Republican response, delivered by Reps. Jennifer Dunn (WA) and Steve Largent (OK), steered clear of solid policy proposals in the health care arena. Dunn, however, stressed that rather than use the budget surplus on more social spending, the president should endeavor to "give it back" to the taxpayers through tax cuts. Largent emphasized the GOP's commitment to "protecting the unborn." He said, "Again this year, overwhelming majorities in both houses will urge the president to end the dreadful and unwarranted practice of partial-birth abortion. We must uphold the sanctity of life amidst the tragedies of abortion, euthanasia and assisted suicide" (text, New York Times, 1/20).