REMARKS BY THE FIRST LADY
DURING A SPEECH TO THE ARC
 October 8, 1993

MRS. CLINTON: Thank you very much for that very
warm welcome. It is such a pleasure to be here with David
Dunn and the other officers and the board of the ARC and all
of those in this audience and around the country who support
the work of the ARC. And I'm also pleased to be here with
the governor of Rhode Island, Governor Sundlun, and both
Senator and Mrs. Pell, who came to be with us today.

And I am particularly pleased to have been
introduced by someone you have known a long time and I've
only been able to claim an acquaintanceship of less than a
year, but whom I admire so greatly, Senator Chafee.

From the very first time that the President asked
me to work on this very important task, he has been such a
constructive and helpful counselor and advisor. And I think
it's only fair to say that we now do have a president who is
committed to health care reform.

And we have leaders like Senator Chafee who have
worked on health care reform for many years who will help
create the climate of cooperation that will lead to a
bipartisan, nationally accepted health care reform in 1994.
And I am very grateful. (Applause)

This is an issue that we know will be very
discussed all over the country in all kinds of forums like
this but even more importantly, in living rooms, in coffee
shops, around the water coolers. People are going to be
talking about health care reform. And I think it is a
conversation that is long overdue and very welcome.

And those of you in the ARC have experience in
knowing what is needed to make systems respond to human
needs. And we are so grateful that the ARC has taken such a
strong stand of support in favor of health care reform.

I want personally to thank the ARC for the very
positive response that you issued in response to the
President's health care speech. And I want to thank David
and others for being with us at the White House when we
kicked off this campaign for health care reform because you
have been working with us through your officers and
representatives now for a number of months.

And your help and your constructive advice has
enabled the administration to come forward with the plan that
has and will continue to make a contribution as we work
through the Congress to the final resolution.

You know, often better than most Americans, how
easy it is to be victimized by a health care system that
discriminates against preexisting conditions, that does not
offer adequate, long-term care choices, such as personal
assistance and other support that people with mental
retardation and their families need to rely on to fulfill
their lives and to be productive citizens.

We are trying in our health care reform approach to
deal with several of the problems that are most important to
the ARC. We want to expand home- and community-based
services to persons with disabilities. (Applause)

You know so well that we have to have the capacity
to support people while they live in their home or in
alternative living arrangements. And that you know so well
that it is the right thing to do, both in terms of the human
connection and in terms of the economic.

For too long we have looked to institutionalized
care. And, as the wonderful introduction of Senator Chafee
pointed out, we're beginning to understand the human and
economic costs that that has made on our society. But we
still have not recognized how much better it would be if we
could provide more support for home- and community-based
arrangements.

The health care reform plan will move beyond even
the legislation that was mentioned and will finally make it
clear that, regardless of income or age, individuals with
severe disabilities should have the option to choose home-
based care or community-based care. (Applause)

Also, as part of the overall plan, we are leaving
in place these programs that have provided help and
assistance. In fact, really, the theme of health care
reform, as far as the President is concerned, is let's
preserve what is right about --

(End tape 1, side 1.)

-- Medicaid home- and community-based waiver
programs. (Applause) In fact, we would like to be able,
assuming we can afford to do so, to increase the living
allowances for residents of ICFMR from the $30 to higher than
that, maybe as high as $100 per month if we're able to do
that. (Applause)

You know, when the President in his speech held up
that health security card -- I hope you saw that on
television. He didn't hold it up and he didn't say, "Well,
you'll only be able to get this if you're a certain age or if
you've never been sick or if you do not have any mental
retardation." He held it up, and he said, "Every American
will be entitled to this card and the services that it will
represent." (Applause) And we want to make that a right
that every American can have. (Applause)

There are so many features of health care reform
that will enshrine this basic principle about every American
being entitled to receive health security and at an
affordable cost that preserves and enhances quality. But
particularly for people with mental retardation and their
families, we see it as a way to end the discrimination that
has for too long existed in our health care system.

I was talking with some friends of mine about their
small business. They employ four people. So there are four
families plus their own on their policy. Several years ago
one of their employees had a child who was born with Down's
Syndrome. And all of a sudden they were faced with what so
many people are faced with everyday in our country.

Do you want to continue to insure this family with
this child? Do you want to have to pay more? Because if you
continue to insure this family, the costs for all your
families will go up. And my friend, whom I have known ever
since high school who is a small businessman, said, "You
know, what a choice for me to be asked to make, to turn my
back on an employee and his family that were part of my
family and my small business, or to reach down even deeper
out of the wages of my employees, out of our profits, and
provide health care insurance."

He continued to do so. And he called me the other
day to say, "You know, I made what I know was the right
choice. It was the right choice for my business. It was the
right choice for my employee and his family. But no American
should have to make that choice. All Americans should be
entitled to health care coverage no matter who they are or
what happens to them during the course of their life."
(Applause) And that is the bedrock principle (inaudible).

In the coming months, as the Senator referred to in
his comments, you will be asked to judge health care reform
by a number of questions. And I hope that you will keep them
in mind as we go forward during this very important
conversation.

In the news release that the ARC issued supporting
health care reform and the President, it said that the ARC
wants to measure any reform against a set of five principles
from a disability perspective, and these are
nondiscrimination, comprehensiveness, appropriateness,
equity, and efficiency.

Everyone of those fits into the principles that the
President outlined and that are also embodied in the
alternative that Senator Chafee has worked so hard on. It
has to be comprehensive. And that means it has to provide a
comprehensive set of benefits.

It cannot discriminate against any American. It
must be appropriate in the sense that we should build on what
works. It should provide access to adequate quality,
affordable health care in appropriate settings based upon the
choices that individuals make that are best for them and
their families.

It must -- it must have equity. And if it is
comprehensive and does not discriminate, it should have
equity. But it needs to have safeguards built in so that all
of us feel that we are not being taken advantage of or
discriminated against.

And it must have efficiency, efficiency in the
better delivery of health care services and a more cost-
effective (inaudible). This will be one of the greatest
debates that we will be having, how much efficiency we are
able to achieve.

But the ARC, for many of the programs that you are
involved with, you have seen models that work. You know more
efficient ways of delivering health care services to people
with mental retardation. That is true across the country.
And what we need is to build in incentives so that efficiency
is rewarded and that those who are inefficient, who don't
deliver high quality care at a cost-effective, affordable
rate, will learn how to do better because there will be
incentives in the system for them to become more efficient.

And we will need your voice and your experiences
speaking loudly to people all over America about how we can
do the job better. I share the confidence and optimism that
Senator Chafee just said in his introduction. I know, I know
we're going to have health care reform in 1994.

We are going to have it because it is the right
thing to do, because we know that to stay with the status quo
is no longer an option, and because so many people, including
those in the ARC, have worked too long and too hard to try to
make things better for us to give up now on what is a
historic opportunity.

So I came today mostly to say thank you -- thank
you not only for the support you have given in the last
months to this health care reform effort, but thank you for
the support and the advocacy and the caring and the examples
you have given to this country for decades.

Our time has finally arrived. If we work together,
we will see the fruits of your labor. And we will all be
proud to be Americans and to live in a country that gives us
the best opportunities in the world, if we are only willing
to take responsibility (inaudible). Thank you all very much.
(Applause)

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