REMARKS BY: DONNA E. SHALALA, SECRETARY OF
HEALTH AND HUMAN SERVICES
PLACE:
The
National Conference of State Legislators, Indianapolis, Indiana
DATE:
July
28, 1999
It's a pleasure to join with the National Conference of State Legislatures for your 25th Anniversary meeting-and to be able to share my thoughts with you today. Of course, whenever I mention "sharing thoughts," I'm reminded of a story about President Teddy Roosevelt.
It seems that Roosevelt had a habit of turning every dialogue into a monologue. In 1909, he was making plans for an African safari after he left office. Hearing that a British expert on the region was in Washington, he invited the man to the White House to share his thoughts and experiences.
After spending nearly two hours alone with the President, the expert left the White House with a dazed look on his face. A reporter finally asked him what he told the President, and the man slowly turned and answered: "my name."
I like that story because it reminds me of how so many federal officials have tended to treat the leaders of state governments. That's why, at the onset, let me tell you that while we've sometimes had our differences, the Clinton Administration has always seen you as our partners.
We want your input. We want your advice. And, believe it or not, we even want your criticism. And, in that regard, I want to thank Bill Pound and his staff in Denver and Washington for their effective and insightful advocacy and, yes, even their criticism.
But, I'm convinced, that we all share in the conviction that if there's one thing America's future depends on above all else, it's the health of America's families. And that includes those members of the American family who have too often been overlooked: Our children, senior citizens and people with disabilities.
I'd like to take a moment today to speak to the needs of each. When it comes to meeting the needs of our children, I'm convinced that it begins by giving a giant booster shot to child care in this country.
The humorist, Sam Levinson, once said: "Insanity is hereditary; you can get it from your children." At the time he meant it as a joke. But if you ever talk to parents stressed-out from trying to balance the needs of their families and the demands of their jobs, you realize he wasn't too far off the mark.
That's why the President's "Child Care Initiative" is so important. It will help provide child care both by increasing the number of children who receive subsidies, and by providing real tax relief for working parents. It will also help support moms and dads who decide to care for their children at home. Just as important, it will provide $3 billion dollars over 5 years to improve the quality of care. train providers.and help states enforce their own health and safety standards.
I know that many states have already taken great strides to strengthen child care. Florida, for example, mandated a reduction in staff-to-child ratios, while requiring more education for teachers at child care centers.
There are other outstanding examples, too. But the bottom line is that we still need to pass the President's Child Care Initiative this year-to ensure that all families.no matter who they are, or where they live.have access to the high quality child care they need. A tax credit for middle-income families isn't enough: we need federal dollars to provide more child care for the hardworking families living just above the poverty line.
Of course, millions of working families have another worry, too: it's that their children have no health insurance. That's why the Children's Health Insurance Program was created-to help expand health insurance to children whose families earn too much for Medicaid, but not enough to buy private coverage.
I'm talking about families like the one headed up by Stacy Meier. Stacy's a 25 year-old divorced mother living in Iowa Falls, Iowa. She works full-time as a family development worker. But even though she has a job, she still couldn't afford the extra $190 a month it would take to make sure her little daughter had health insurance.
Well, now, thanks to CHIP, she can. And she's not alone. To date, 52 U.S. states and territories have had their CHIP plans approved by my department.and countless children have a fighting chance to lead healthier lives.
But we still have one more challenge. Now that the programs are in place, we need to reach out to more parents like Stacy to get eligible children into CHIP or Medicaid. After all, the ultimate success of the CHIP program depends on reaching the children who need it.
Again, many states are on the leading edge of outreach activities. Indiana-your host for this meeting- increased its number of CHIP enrollment sites. And they awarded grant money to counties to develop outreach efforts. Thanks to their initiative, Indiana has already exceeded its original enrollment goal.
We want to help build on efforts like these. That's why we'll continue to promote best practices, fund outreach campaigns, and produce radio ads. That's why we're organizing workshops and conferences throughout the country and spreading the word about our National Toll Free number: 1-877-KIDS- NOW.
But, if we really want to provide our children with a healthy future-then we also have to ensure that it's not clouded by tobacco. We've all heard the statistics: Each day 3,000 young people become regular smokers-and 1,000 will die sooner as a result.
It's no wonder that our Surgeon General, Dr. David Satcher, has said that the single most promising health intervention today isn't the development of any new drug-it's the opportunity to invest the $246 billion dollar settlement with the tobacco companies into smoking prevention.
Last week USA Today ran a thoughtful editorial by Bill Pound. In it, your executive director said it's up to the states to decide how to allocate the tobacco money. I have no argument with that. I think we agree that a "one size fits all approach" to tobacco control just doesn't work.
But state leaders now have a unique opportunity to provide the resources available that can help keep young people from ever starting to smoke while helping others to quit. You also have the chance to help combat tobacco-related diseases and protect people from exposure to tobacco smoke. And we shouldn't let this opportunity slip through our fingers. If we do, the future of too many of our nation's children will simply go up in a puff of smoke. Of course, as we work together to address the needs of our children, we can't forget those members of the American family at the other end of life's spectrum-our senior citizens.
I'm sure that everyone here is familiar with President Clinton's plan to strengthen Medicare's finances while modernizing its benefits -- and that includes providing a prescription drug benefit for the first time ever. It's a prudent, carefully crafted proposal that guarantees the quality care beneficiaries need, but at a price America can afford.
But, I must tell you, all of our efforts to strengthen and improve Medicare will be in jeopardy should Congress pass a tax cut on the scale of the one it's now considering. In fact, the tax cut plan the House recently passed wouldn't only undermine Medicare -- it could very well help derail the economic expansion that helped make the surplus possible to begin with.
We need to make Medicare stronger, not weaker. And that doesn't only mean modernizing it for our parents and future generations. It also means readying it to meet the challenges posed by the Year 2000 computer problem. And, in that regard, I'm glad to report that Medicare is Y2K ready and has been for some time. Achieving Y2K compliance is one of our top priorities, and we'll continue to work with the states to ensure that Medicaid will also be "Y2K O.K." before the end of the year.
But, as you know, one specific concern to many senior citizens is how the computer problem could affect the supply of prescription drugs. Let me address that.
In May, the President's Council on Year 2000 Conversion convened a meeting of pharmaceutical, patient advocate, and health care industry representatives to examine the Y2K readiness of the pharmaceutical supply system. Last month, the Council announced that consumers can be assured a continued supply of medications through the new year. As we typically recommend, consumers should refill prescriptions when they have a five-to-seven day supply of drugs remaining.
The pharmaceutical supply system operates with a 90-day inventory and is prepared to meet emergency situations as they arise. That's why I want to discourage new laws that force insurance plans to reimburse those with prescription benefits for a 60 to 90 day supply of medication before the end of the year.
Prescription drugs concern everyone, but there are some members of the American family that have unique needs that we must address. I'm talking about people with disabilities.
In June, the Supreme Court issued an important decision in a case that's familiar to many of you: the Olmstead case. The Court ruled that when a professional determines that a disabled individual can live in the community -- and can be served there effectively -- the person must be given the choice of doing so. If I were disabled I would want this choice -- and so would you.
In our view, the Court issued a very balanced and thoughtful decision in this case. Yes, the Court said, if community-based alternatives exist, then we are discriminating if a person who can benefit from community care-and who wants to live in the community-is institutionalized.
At the same time, the Court said we must acknowledge that states have limited resources. The Court's decision doesn't require any state to incur excessive new costs. It does, however, require states to move at a reasonable pace to provide community-based alternatives. And the Court also said states can meet their obligations by having comprehensive plans.
We support this. The Olmstead decision defines our mission: To build better systems of supports enabling people with disabilities to live life to the fullest. That's the job we need to do-and I think we ought to welcome it.
And as we move to implement the Olmstead decision, there are three basic principles that all of us can agree on, now. We can agree that no American should have to live in a nursing home or state institution if that individual can live in a community with the right mix of affordable supports. We can agree that we all have the right to interact with family and friends in our communities.to make a living.and to make a life. And we can agree that it will take time, effort, creativity and commitment from all of us to make this a reality.
Over the past years, my department has initiated a lot of activities to help transition people out of nursing homes and other institutions. We've focused on expanding and promoting home and community-based services. We've offered support and technical assistance to states. And we've used the flexibility of the Medicaid program to pursue our goals. In just the last year, we've developed legislative proposals and funded state grants to move people out of nursing homes.
The Olmstead decision proves that we've been moving in the right direction. Now it's up to all of us to work together to implement the ruling as quickly as possible. To that end, we're ready to meet with you and others to discuss ways to work together to carry out the Olmstead decision. And that includes discussing the technical assistance we can provide.
NCSL has long been a leader in informing state policy makers about quality home and community-based services. I commend you for your work, but I also want to challenge you to do even more.
When you do, keep in mind that Olmstead furthers our ultimate goal: a nation that integrates people with disabilities into the social mainstream, promotes equality of opportunity, and maximizes individual choice.
Last week, during all the news coverage surrounding the death of John F. Kennedy, Jr., I couldn't help but remember something his uncle -- Robert Kennedy -- often used to say. Quoting George Bernard Shaw, he would say that while some see things as they are and ask "why" he would dream things that never were and ask "why not?"
As policy makers, I think it's our obligation to do the same. To not only consider the problems facing our states -- and our nation -- but to offer a vision of what could be. A vision of an America where every child has the chance to grow up in good health. A vision of an America where older and disabled people live their lives to the fullest. In short, a vision of an America where every family is able to move ahead and where no one is ever left behind.
That's my dream for America. And I think that it's your dream, too. That's why I want to ask that when you go back to Columbus or Austin or Sacramento -- or wherever your state capital is -- you take just a moment to think about that dream again. And when you do, ask yourself: "why not?"
Thank you.
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