This is an archive page.  The links are no longer being updated.

Remarks by :	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		The March of Dimes Foundation for Birth Defects
		Volunteer Leadership Conference, Washington D.C.
DATE: 		September 26, 1997

I was thinking about that history as I prepared this speech. I was thinking about all of those who came before us -- and how much they were able to accomplish for our nation's children by standing up, speaking out, and never ever giving up. Never giving up.

We are here because, exactly 40 years ago, our government and our citizens didn't give up at Little Rock High School. In the face of anger and division, we fought to ensure that the doors of opportunity would stay open for all of our children. We are here because women like the late Mother Theresa and Princess Diana did not give up. They used the power of caring to turn small acts of kindness into miracles for children all over the world.

When the March of Dimes Ambassadors lay a wreath at the FDR Memorial today, they will be there because leaders like President Roosevelt didn't give up. Now, 60 years after President Roosevelt founded the March of Dimes, we are all here this morning because you have never given up. You have never given up. And this country is the better for it.

When faced with the scourge of polio, you didn't give up. Now, we are on the brink of wiping out polio -- not just in the United States. Not just in the developed world. But in the entire world.

But, that's not all. Because of this President, this Administration, and this organization -- because none of us gave up -- we have been able to write a new history for our children's health.

Just think about what we've been able to accomplish in the last four years alone. Infant immunization rates are at an all-time high, and vaccine-preventable childhood infectious diseases are at an all time low. American food manufacturers will start fortifying "enriched" foods with folic acid -- so that women can help reduce their children's chances of birth defects. Infant mortality rates are at their lowest levels in history. And more than 80 percent of pregnant women are getting prenatal care in their first trimesters.

We all know that Healthy Start works to increase prenatal care and decrease infant mortality, low birth weight and other health problems facing women, infants, and their families. That's why today, I am pleased to announce $50 million in Healthy Start grants that will reach 40 new communities with high infant mortality rates.

We should be proud of that.

Just like we should be proud, that for the first time in history, we have a President with the courage to take on the tobacco industry and save our children from a deadly addiction. We need sweeping national legislation to stop our kids from smoking. And, at the end of the day, it must be guided by the only bottom line that matters: Will it protect the health of our children? That has always been your bottom line -- and we must ensure that it is always our nation's bottom line.

But we have some unfinished business to attend to. Which is why I have come here today: To ask you to rewrite history once again. This time for the 10 million children in America who don't have health insurance. The majority of these children have parents who work hard, but are too poor to afford private insurance, not poor enough to be eligible for Medicaid, and just poor enough to fall through the cracks. Our uninsured children: They are the ones who are less likely to get annual check-ups, children who are four times as likely to delay needed care for acute conditions, more likely to miss school because of illness, and, more likely to get care from an emergency room physician. In short, these are children who, at a time when they should be full of promise, are facing enormous barriers in their ability to grow, learn and reach their God- given potentials.

You fight for these children every day. No one understands their problems better. And no one is better poised to help solve them. Which is why, one year ago, at this very conference, Jennifer stood up and talked about this challenge. Since then, you have fought, and our President has fought for an initiative to help dramatically decrease the number of uninsured children in America. And we did it.

The balanced budget agreement includes an unprecedented 24 billion dollar commitment to cover as many as half of our uninsured children. That is the largest expansion of health insurance in more than 30 years.

Let me be clear: We now have the opportunity -- and the ability -- to take a significant step forward in improving the health of this country's children. Now there is only one thing left to do: We must make it happen. We need your continued leadership every step of way.

You can play an integral role in designing and implementing State Plans. You can continue to bring the voice of our children -- especially our children with special needs -- into our communities, our legislatures, and our State Houses. Because, like Medicaid, the new Children's Health Insurance Program will be a true partnership between the states and the federal government.

The states will design their own programs, submit them to our Department for approval, and show that they can match the funds that we provide and meet other important requirements of the law. Once the states do this, and we have approved their plans, the money will be available to them anytime after October 1st.

Our goal is your goal: We want to see as many children insured as possible, as quickly as possible and, most important, as effectively and comprehensively as possible. To do that, we will continue to provide guidance and assistance to the states, as we have already done with the template we created to help them craft their plans.

And to do that, we must be guided by four key principles:

Principle number one: Flexibility: We do not have one children's health insurance problem. The challenges of North Dakota will be different from Louisiana. The children's needs in California will not mirror the needs in Rhode Island. The health care system in Texas won't look like the one in Ohio. And neither will their plans.

It is up to every state to design a program that best suits their communities, their system of health care and their children's needs. That's why we've already granted 17 Medicaid waivers that are expanding insurance coverage to 2.2 million citizens - most of whom are children.

And that's one of the reasons why we're giving the states three broad options for covering uninsured children in their states: They can choose to expand their existing Medicaid program to make more children eligible for it; they can choose one of three benchmark plans offered in their states, or its equivalent; or, they can choose to come up with a plan that will do a combination of both. But, no matter what options states choose, their coverage must be comprehensive.

Which is my second principle: Comprehensive Coverage: There must be comprehensive benefits for every child with health insurance. If a state chooses to create a new plan, the plan must include inpatient and outpatient service. It must include physicians' surgical and medical services. It must include laboratory and X-ray services. It must include well baby and child care services. It must include immunizations. And it can include much more.

My third principle is Accountability: We've all heard the saying, "We did everything right, we just didn't get the results we wanted." When it comes to providing quality health insurance to our children, when it comes to protecting them against sickness or even death, that kind of attitude just won't cut it.

All of us -- all of us -- have fought hard for this historic opportunity. All of us must be accountable for the results. Working with the states, we must work to enroll babies promptly. We must be sure that children with special needs get the care they need. And we must always make sure that we are insuring new children -- not displacing current coverage.

Our guidelines are clear: If your children are eligible for Medicaid now, they must stay that way. All states must continue to enroll eligible children in Medicaid. And, they must help ensure that private plans will not drop children in hopes that our new initiative will pick them up.

So, how do we enroll these new children? How will we get the results we need?

The answer is my fourth and final principle: Outreach. We know that this initiative will only work if we reach the kids who really need it. But, these kids are not uninsured for the same reasons. As I said, the majority are children with parents who are low-income, but employed. Many of the children are eligible for Medicaid and don't receive it -- often because their parents don't even know they qualify. And some children float in and out of eligibility for Medicaid because their parents divorce, become unemployed, or move from welfare to work.

If we are going to reach these kids, really reach all of them, then we must commit ourselves to reaching them where their families live, work, go to school, pray and play. All around the country, we have seen innovative models: Pennsylvania launched a grassroots outreach campaign. Florida distributed brochures and applications in schools. Vermont gave their early children's insurance program its own name and identity: Dr. Dynasaur.

Now, it is up to us to enlist child care centers, Head Start and Healthy Start. We need to reach out to businesses, community health centers, and HMOs. We need doctors, nurses, teachers, religious leaders, and media leaders -- everyone who comes into contact with children. We must create a seamless system so that no child falls through the cracks. Because, when all is said, and done, that is how we will be judged -- not by what we say today, but by what we do tomorrow.

We must ask ourselves: Will we, like the Little Rock Nine, like Mother Theresa and Princess Diana, like FDR -- will we continue to rewrite the history of children's health in this country? Will we help ensure that every child has access to quality health care? And will we be a country that is great because it is good? We will. But only if we continue to join together -- as we do today. Only if you continue to stand up, speak out, and never give up. Only if you continue to lead.

Thank you.