Since the start of his Administration, President Clinton has made an extraordinary commitment to making health care more affordable, accessible, and effective for all Americans. In 1998, the Administration took significant steps towards this goal, despite the lack of action in Congress on major health issues. Medicare beneficiaries gained access to new preventive benefits, managed care choices, and low income protections. The no-tolerance approach towards Medicare fraud was stepped up, yielding hundreds of millions in savings.

Although Congress did not respond to the President's call to pass a strong, bipartisan, and enforceable Patients Bill of Rights, the President, by executive action, extended patient protections to all Medicare and Medicaid beneficiaries and Federal employees. He also took immediate action to improve the quality of care in nursing homes. Finally, the President worked with States to expand health insurance coverage to the 43 million uninsured Americans. All but three States have begun to enroll over 2.5 million uninsured children in the new Children's Health Insurance Program (CHIP); over 10 Federal agencies have joined with the private sector to help enroll the millions of uninsured children eligible for Medicaid as well as CHIP; and the President authorized a new regulation that provides States with the option to cover two parent families in Medicaid for the first time.

This year's budget builds on that effort, including $6 billion over five years for an initiative to help patients, families, and caregivers cope with the burdens of long-term care; $2 billion over 5 years for an initiative that eliminates barriers to employment for individuals with disabilities; new proposals to improve access to health insurance; new proposals to safeguard and improve the public health and strengthen the safety net; and aggressive efforts to improve the management of Medicare and Medicaid.

LONG-TERM CARE

· $1000 Tax Credit. This new tax credit compensates for a wide range of formal or informal long-term care for people of all ages with three or more limitations in activities of daily living (ADLs) or a comparable cognitive impairment. This proposal would benefit about 2 million Americans and costs $5.5 billion over five years.

· National Family Caregivers Program. The budget provides $625 million over 5 years for this program, which is designed to assist approximately 250,000 families caring for elderly relatives who are chronically ill or disabled. It will support a caregiver support system in all states that provides information, education, counseling, and respite services directly to care-giving families.

· National Campaign to Educate Medicare Beneficiaries about Long-term Care Options. This $10 million campaign would provide Medicare beneficiaries with information about State administered home and community based care options including: what long-term care Medicare does and does not cover; Medicaid and Older Americans Act programs; and what to look for in a quality private long-term care policy.

· Offering Quality Private Long-term Care Insurance to Federal Employees. Proposal allows OPM to offer non-subsidized, private long-term care insurance to all federal employees, retirees, and their families at group rates. Roughly 300,000 Federal employees are expected to participate in this program.

· Helping More Older Americans Remain in Their Communities Through New Broad-based Assisted Living Initiative. This proposal provides $100 million in competitive grants to enable existing HUD elderly subsidized (Section 202) projects to convert some or all units into Assisted Living facilities that provide additional services many older Americans need to continue living as independently as possible.

· New Community Based Long-term Care Options. This proposal would provide States with a new option to eliminate the institutional bias in Medicaid and provide Medicaid coverage to individuals of all ages with income up to 300 percent of SSI who have been determined to require an institutional level of care but continue to live in residential rather than settings.

· Nursing Home Quality Initiative. This proposal will provide $110 million to strengthen Federal oversight of nursing home quality and safety standards by working with States to improve their nursing home inspection systems, crack down on nursing homes that repeatedly violate safety rules, establish a national registry of abusive nursing home workers, and publish nursing home quality ratings on the internet.

ELIMINATING BARRIERS TO EMPLOYMENT FOR INDIVIDUALS WITH DISABILITIES

· Funding the Work Incentives Improvement Act in the President's Budget. The FY 2000 budget includes the full Work Incentives Improvement Act. This proposal, which costs $1.2 billion over 5 years, would improve access to health care by providing new options for workers with disabilities to buy into Medicaid and Medicare; modernizing employment-related services for workers with disabilities; and creating a work incentives grant program to provide benefits planning and assistance and better integrate services to people with disabilities working or returning to work.

· $1,000 Tax Credit. Under this proposal, workers with significant disabilities would receive an annual $1,000 tax credit to help cover the formal and informal costs that are associated with and even prerequisites for employment, such as special transportation and technology needs. This tax credit, which will help 200,000 to 300,000 Americans costs $700 million over 5 years.

· Improving Access to Assistive Technology. This new $35 million initiative would accelerate the development and adoption of information and communications technologies, which can improve the quality of life for people with disabilities and enhance their ability to participate in the workplace.

EXPANDED HEALTH INSURANCE OPTIONS

· Health Options for Older Americans. This new initiative expands the health options available for older Americans by: enabling Americans aged 62 to 65 to buy into Medicare, by paying a full premium; providing vulnerable displaced workers ages 55 and older access to Medicare by offering those who have involuntarily lost their jobs and their health care coverage a similar Medicare buy-in option; providing Americans ages 55 and older whose companies reneged on their commitment to provide retiree health benefits a new health option, by extending "COBRA" continuation coverage until age 65. The President's proposal is fully funded and does not burden the Medicare Program.

· Encouraging Small Businesses to Offer Health Insurance. This new initiative encourages small businesses to offer health insurance to their employees through: a new tax credit for small businesses who decide to offer coverage by joining coalitions; encouraging private foundations to support coalitions by allowing their contributions towards these organizations to be tax exempt; offering technical assistance to small business coalitions from the Office of Personnel Management.

· Improving Access to Health Insurance through Medicaid and CHIP. The budget increases access to health insurance by restoring Medicaid and CHIP eligibility for legal immigrants affected by welfare reform; extending Medicaid eligibility to foster children up to age 21; improving transitional Medicaid for people moving from welfare to work; and providing states with $1.2 billion over 5 years for children's health outreach activities. The budget provides $144 million over five years for increased CHIP funding for Puerto Rico and the territories.

COMMITMENT TO PUBLIC HEALTH

· Tobacco. The budget provides an increase of $34 million (up 100% from 1999) for greater enforcement by the Food and Drug Administration and an increase of $27 million (up 36%) for CDC state tobacco control activities. (See separate paper on tobacco).

· Providing Access to Health Care Services for Uninsured Workers. This initiative invests $1 billion over 5 years in comprehensive health care delivery systems that traditionally provide services the uninsured.

· Mental Health Block Grants. The budget provides $359 million, a 24 percent increase over 1999 and the largest increase ever.

· Ryan White HIV/AIDS Treatment Grants. The budget provides $1.5 billion, a 7 percent increase over 1999 funding levels.

· Childhood Asthma Initiative in Medicaid. The budget provides $50 million in demonstration grants for States to test innovative asthma disease management techniques for children enrolled in Medicaid.

· Family Planning Services Grants. The budget provides $240 million, an 11.6 percent increase over last year's funding level.

· Reducing Racial Disparities in Health Status. The budget includes $145 million for health education, prevention, and treatment services for minority populations. The budget also proposes an additional $50 million to address HIV and AIDS issues in minority communities.

· Supporting Graduate Medical Education at Children's Hospitals. The budget proposes $40 million to support graduate medical education at freestanding children's hospitals, which play an essential role in the education of the nation's pediatricians.

· Biomedical Research. The budget provides $15.9 billion for the National Institutes of Health (NIH), a $320 million increase over the $2 billion increase in 1999. The NIH budget builds on the President's committment to biomedical research as a foundation for combating disease and providing new technologies.

· Medicare Cancer Clinical Trials. The budget provides $750 million over four years for a demonstration to give more Americans access to cutting-edge cancer treatments.

· Controlling the Spread of Infectious Disease. The budget will include $25 million, a 31 percent increase over last year's funding level, for a new CDC initiative that funds disease surveillance and rapid response activities, a national educational campaign about the consequences of inappropriate antibiotic use, and research on disease risk factors.

· Bioterrorism. The Budget provides $230 million for HHS' bioterrorism programs, an increase of $71 million (45 percent) over the last year's funding.

· Indian Health Service. The Budget provides a substantial $170 million increase over the 1999 funding level to: expand health care to 1.4 million Native American/Alaska Natives who use its services; support tribal self-determination by adding $35 million for contract support costs; construct additional health facilities; and finance an additional 100 public health nurses for outreach.

·Improving Food Safety with Increased Inspections and Surveillance. The budget includes an additional $105 million -- a 12 percent increase -- to ensure food safety by improving inspections for both domestic and imported food and by enhancing surveillance efforts.

IMPROVING THE FISCAL INTEGRITY AND EFFICIENCY OF MEDICAID AND MEDICARE

· Health Care Financing Adminstration (HCFA) Management Reform. HCFA, HHS and the Office of Managment and Budget have begun the development of a reform initiative that will increase HCFA's flexibility to operate as a prudent purchaser of health care while also increasing accountablilty. The initiative has five components: 1) management flexibilities; 2) increased accountability; 3) program flexibilities; 4) structural reforms; and 5) contractor reform.

· Medicare and Medicaid Program Integrity and Efficiency. The budget includes a number of policies that would reduce fraud, waste, and overpayments in Medicare and strengthen fiscal accountability in Medicaid. These savings amount to $1.26 billion for Medicare and $74 million for Medicaid in FY 2000.