U.S. Department of Health & Human Services
Improving the health, safety, and well-being of America	Frequent Questions Search

Font Size     Print     Download Reader

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 The links are no longer being updated.

THE PROMISE OF A SAFE AND HEALTHY CHILDHOOD

As we stood at the threshold of the new millennium, providing a safe and healthy childhood for our children remained a top priority for the Clinton administration in 1999. After years of effort, immunization rates against childhood diseases reached record highs, and vaccine-preventable disease incidence reached record lows. Head Start received the largest single year budget increase in its history. Fewer young people smoked cigarettes, used illegal drugs, or had children of their own. More children in the foster care system were adopted than ever before, with states on track to reach the President's goal of doubling the number of adoptions by 2002. More children of divorced and separated parents received child support payments, even as we made it easier for them to receive health insurance from their non-custodial parents as well. The Supreme Court took up the issue of FDA jurisdiction over tobacco, even as we pursued other strategies to reduce youth smoking. And expansions in the Medicaid and SCHIP programs improved the health care available to millions of children.

Adoption and Foster Care. In 1999, the Administration for Children and Families (ACF) awarded $20 million in the first adoption bonuses to 35 states that had increased the number of children adopted from foster care. Thirty-six thousand foster care children were adopted in fiscal year 1998, an increase from 31,000 in 1997 and 28,000 in 1996. These numbers indicate that we are on the way to meeting the President's goal of doubling the number of children adopted from foster care by the year 2002.

On December 14, President Clinton signed into law the Foster Care Independence Act of 1999. This legislation will help ensure that young people who leave foster care get the tools they need to make the most of their lives. HHS will provide $270 million over the next five years to increase funding for the Independent Living Program, which provides assistance for the nearly 20,000 young people leaving foster care each year at the age of 18 without an adoptive family or permanent home. HHS also announced that national child abuse and neglect statistics continued a four-year decline, and approved eight more child welfare demonstrations.

Child Support Enforcement. Since taking office, the Clinton administration has made child support enforcement a critical priority. The National Directory of New Hires, which matches child support orders to employment records, found more than 2.8 million delinquent parents in its two years of operation. Paternity establishment rose to 1.45 million in 1998, a more than three-fold increase from 516,000 in 1992. The Passport Denial Program collected more than $2.25 million in lump sum child support payments and is currently denying 30 to 40 passports to delinquent parents per day. And under the federal tax offset program, the federal government collected a new record amount of $1.3 billion in overdue child support from federal income tax refunds for tax year 1998. Nearly 1.4 million families benefited from these collections, which represented an 18 percent increase over the previous year and a 99 percent increase since 1992.

Head Start Program. Head Start is the nation's premier early childhood development program for low-income children and families. The program has an unprecedented track record of preparing children to start school ready to learn. Since 1995, Early Head Start has served infants and toddlers in recognition of the clear evidence that the earliest years are the most important to children's growth and development. The President proposed and Congress enacted $5.3 billion for Head Start program in fiscal year 2000, $607 million more than fiscal year 1999 and the largest single year budget increase it has ever received. Under the Clinton administration, Head Start has grown from 714,000 children in 1993 to 877,000 children with the budget agreement. Early Head Start will expand to support nearly 45,000 children aged 0 to 3 and their families. This increase keeps Head Start on track to reach the President's goal of enrolling 1 million children by 2002. In addition to expansion, funds will be used for raising the quality of programs, including improving school readiness, enhancing staff training, obtaining safer and better equipment, and reducing class size and staff turnover.

Teen Pregnancy. In October 1999, HHS announced that the teen birth rate fell for the seventh straight year and reached its lowest level since 1987. We also released a new guide to help local communities and non-profit organizations establish successful teen pregnancy prevention programs. The guide, "Get Organized: A Guide to Preventing Teen Pregnancy," stresses a localized approach, a long-term commitment and careful evaluation. This three-volume publication also includes strategies for collecting basic data, reaching out to religious leaders and conducting program evaluation.

Rise in Childhood Immunizations. On September 23, CDC announced that the nation's overall immunization rate for preschool children increased to a record 80 percent in 1998, the highest rate ever recorded. Because childhood vaccination levels in the United States are at an all-time high, disease and death from diphtheria, pertussis, tetanus, measles, mumps, rubella and Hib are at or near record lows. There was only one reported case of diphtheria, 100 reported cases of measles, and no reported cases of wild poliovirus for 1998.

Children's Hospitals Graduate Medical Education (GME) Program. In December 1999, President Clinton signed the Healthcare Research and Quality Act of 1999 establishing HHS' Children's Hospitals GME program to be managed by the Health Resources and Services Administration's (HRSA) Bureau of Health Professions. In fiscal year 2000, HRSA will provide $40 million to nearly 60 freestanding children's teaching hospitals serving low-income or uninsured children for training resident pediatricians.

Youth Smoking. Every day, 3,000 children become smokers and 1,000 have their lives shortened because of it. According to the l999 Monitoring the Future Study, past month use of cigarettes decreased from 19.1 percent to 17.5 percent among 8th graders, but overall cigarette smoking among teenagers did not change during 1999, which emphasizes the importance of continuing our efforts on reducing youth tobacco use.

In April 1999, the Clinton administration took an important step in preventing and reducing tobacco use, as more than 3,000 tobacco industry billboards across the country were removed and replaced with an array of new messages discouraging tobacco use and promoting good health. Three HHS agencies--CDC, FDA and the National Cancer Institute (NCI)--collaborated with the National Association of Attorneys General and 37 individual states and the District of Columbia that had replacement billboards to organize this nationwide effort.

HHS also worked to encourage states to use their funds from the 1998 settlement with the tobacco industry to reduce youth smoking and promote public health. CDC released two state-specific reports on tobacco use in August, one highlighting the severity of the public health problem and the other presenting a science-based blueprint for solving it. And in September, CDC began funding the tobacco control programs in all 50 states, the District of Columbia, and U.S. territories. This effort provides funds and technical support to states and serves as a building block for coordinated national tobacco control efforts today and into the next millennium.

By the end of fiscal year 1999, the FDA had arranged for tobacco retailer inspections under the agency's final rule in all 50 states and three territories. FDA has also conducted more than 150,000 inspections through the end of fiscal year 1999. FDA's effort to reduce youth access to tobacco products is already having an impact. According to the announcement of the most recent Monitoring the Future study, "[R]eported accessibility has been falling since 1996, particularly among the eighth-graders...This suggests that the efforts by federal and state governments are starting to have an effect...The U.S. Food and Drug Administration has been assisting states in monitoring retailer behavior and levying penalties on retailers who sell to underage buyers."

In October, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that average retailer sales rates of tobacco products to minors dropped by nearly half, from 40 percent in 1997 to 24 percent in 1998. This new data reflects not only a substantial decline in retailers' sales of tobacco to children, but also the growth of effective state tobacco enforcement programs that have been established as a result of the Synar program, which requires states to reduce youth access to tobacco by enforcing their laws prohibiting the sale of tobacco products to anyone under age 18.

HHS also continues to work to provide the public with as much information as possible on the health dangers of tobacco. As a result of an Executive Memorandum issued by President Clinton, HHS announced a single federal source for Internet access to more than 27 million pages of tobacco industry documents that illustrate the health dangers of tobacco. The new Web site www.cdc.gov/tobacco, hosted by CDC, allows users to conduct full-text searches of key documents made public as a result of state lawsuits, congressional subpoenas and the 1998 master settlement agreement between the states and tobacco companies.

Youth Substance Abuse Decreases. Results from the 1999 National Household Survey on Drug Abuse released in August and the 1999 Monitoring the Future Survey released in December showed that overall drug use among teenagers has declined or remained level for three consecutive years. Both surveys showed that among youths age 12-17, the disapproval of smoking marijuana once or twice a week increased between 1997 and 1998. This measure provides an important marker of drug use that can help explain the patterns and trends in substance use, particularly among youths. Teens alcohol use has decreased slightly since 1992 although daily use of alcohol remains unacceptably high.

In October, SAMHSA awarded State Incentive Grants for Community-Based Action in 20 states and the District of Columbia to support planning for coordinated substance abuse prevention services. SAMHSA also awarded Starting Early-Starting Smart Grants to examine the effectiveness of integrating substance abuse and mental health services into primary care settings and into early childhood service settings. SAMHSA also announced new Targeted Capacity Expansion Grants to assist local governments and American Indian and Alaska Native Tribal governments to address serious, emerging drug problems at the earliest possible stage.

HHS' efforts to reduce marijuana use among America's youth continue through its comprehensive Marijuana Initiative begun in 1995. As part of this initiative, HHS has funded new research on the effects of marijuana, and launched major prevention-oriented campaigns -- such as the anti-marijuana campaign "Reality Check" -- to help parents educate children about the dangers of drugs. As part of this effort, SAMHSA also provided free materials, such as "Marijuana: What Parents Need to Know," "Tips for Teens," and "Keeping Youth Drug Free." SAMHSA's Center for Substance Abuse Treatment is currently engaged in two multisite studies to determine the relative effectiveness and cost-effectiveness of several interventions aimed at eliminating marijuana use in both adolescents and adults.

As part of a national initiative to combat the increasing use of club drugs, the National Institute on Drug Abuse (NIDA) announced in December, that it will raise its funding for research about club drugs and what to do about them by 40 percent, bringing the total committed to this important effort to $54 million. In addition, NIDA and four national organizations launched a multimedia public education strategy to alert teens, young adults, parents, educators and others about the dangers of club drugs such as Ecstasy, GHB and Rohypnol, which are often used at all night "raves" or dance parties and have potentially life-threatening effects.

THE PROMISE TO MOBILIZE AMERICA'S SCIENTIFIC GENIUS TO MAKE OUR COUNTRY A HEALTHIER AND SAFER PLACE TO LIVE

This year marked a major milestone in our understanding of the basic blueprints of life, as scientists completed the first full map of a human chromosome. We also proposed new medical privacy regulations to ensure that American's confidential health records are protected even as we search for new cures and new drug therapies. FDA and CDC took new steps to improve food safety and make drug labels easier to read. The department's efforts to reduce research risks and scientific misconduct were improved. And we increased our coordination with other agencies to improve our preparedness for a pandemic or a bioterrorist attack.

Protecting Patients Personal Medical Records. On October 29, 1999, President Clinton and Secretary Shalala announced the first-ever set of national standards to protect the privacy of Americans' personal health records. The standards will apply to medical records created by health care providers, hospitals, health plans and health care clearinghouses that are either transmitted or maintained electronically, and the paper printouts created from these records. The proposal reflects the principles outlined by Secretary Shalala in September 1997 as part of her recommendations for protecting the confidentiality of individually identifiable health information. The proposed standards would enhance the protections afforded by many existing state laws. In circumstances where the federal rules and state laws are in conflict, the stronger privacy protection would prevail. The proposed privacy standards would protect consumers whether they are privately insured, uninsured, or participants in public programs such as Medicare or Medicaid. At the same time, the Clinton administration called on Congress to enact comprehensive privacy legislation.

Increasing Funding for Biomedical Research. President Clinton's 1998 proposal for a 21st Century Research Fund has resulted in a dramatic increase in biomedical research funding for NIH over the past two years. The President's commitment to expanding the NIH budget has resulted in a $4.3 billion increase since 1998. These new resources will allow us to boost the number of funded research grants to an all-time high so that we can carry out essential biomedical research to prevent and combat diseases like Alzheimer's, AIDS, and cancer. President Clinton also proposed and Congress granted a 20 percent increase in funding for critical health services research at the Agency for Healthcare Research and Quality (AHRQ). NIH also announced new guidelines for stem cell research, which has the potential to find cures for many serious diseases.

Mapping the Human Genome. In December 1999, scientists in England, the United States and Japan, working under the umbrella of the ambitious international Human Genome Project, announced that they have unraveled the DNA code of an entire human chromosome. Their sequence of the 33 million DNA letters of chromosome 22 represents the longest continuous stretch of DNA code ever to be deciphered. This achievement is especially exciting because we can now see many future milestones that will occur with increasing speed and more chromosomes whose DNA code will be completely sequenced, unlocking the mysteries of many inherited and genetic disorders.

Protecting Research Subjects and Improving Research Integrity. In June, we announced our intent to further strengthen our resolve to ensure the safety and welfare of people who participate in HHS-sponsored research studies by moving the Office for Protection from Research Risks (OPRR) from NIH to the Office of the Secretary. The OPRR director will now report to the assistant secretary for health, and a new advisory committee on protection from research risks also will be created. These new initiatives complement the oversight roles of other HHS agencies in protecting research subjects already in place, including the FDA's responsibility in approving all clinical trials aimed at testing a new drug or medical device, and the NIH's important patient safety guidelines that must be followed in any research the agency funds. Additionally, NIH also has a special panel, the Recombinant DNA Advisory Committee (RAC) that provides oversight and public discussion of gene transfer clinical research.

On October 22, Secretary Shalala accepted the recommendations of a special review group on research misconduct and research integrity involving research funded by agencies of the U.S. Public Health Service. The recommendations include a more precise and useful definition of research misconduct, which is being adopted by agencies throughout the federal government. They are also aimed at improving the process for investigating allegations of misconduct, and at expanding educational efforts to prevent misconduct.

Protecting Against Bioterrorism. CDC awarded $40 million to states and major cities to expand and upgrade their ability to detect and respond to biological and chemical agents and bioterrorist acts in the U.S. These grants were part of a total of $124 million in fiscal year 1999 CDC funding to prepare against bioterrorism. In fiscal year 2000, departmental funding to prepare against bioterrorism totals $267 million. This includes $155 million for CDC to expand and upgrade state and local capacity to detect and respond to biological and chemical agents, and to provide a public health response to bioterrorism. Also included is $25 million for the Office of Emergency Preparedness (OEP) to continue development of the Metropolitan Medical Response System and training for Disaster Medical Assistance Teams and National Medical Response Teams. Finally, the department's budget for bioterrorism response includes $87 million for research and evaluations, of which $30 million is for research and development of new generation vaccines for smallpox and anthrax, two of the five critical agents identified as leading terrorist threats.

Food Safety. Continuing their joint efforts to combat foodborne illness, FDA, HHS and the U.S. Department of Agriculture's Food Safety and Inspection Service announced in July 1999, important new measures to prevent illnesses caused by contaminated eggs. The FDA has required safe handling statements on labels of shell eggs to warn consumers about the risk of illness caused by Salmonella Enteritidis (SE). For the first time, there is a uniform federal requirement that all eggs and egg products packed for consumers be refrigerated at 45 degrees or below. In addition, the President's Council on Food Safety developed a strategic plan to further improve the safety of shell eggs and processed egg products. The fiscal year 2000 appropriation for HHS includes an increase of $40 million to carry out the President's Food Safety Initiative. This includes $30 million in FDA (for a total of $79 million) and $10 million in CDC (for a total of $29.5 million).

New, Easy to Understand Labels. To help consumers make informed decisions about the medications they use and give their families, the FDA announced a new regulation to provide new, easy-to-understand labeling on nonprescription drugs. The regulation calls for a standardized format that will improve the labeling on drugs Americans use most--nonprescription or over-the-counter (OTC) drugs. By clearly showing a drug's ingredients, dose and warnings, the new labeling will make it easier for consumers to understand information about a drug's benefits and risks as well as its proper use.

Delivering High Quality Health Care. The Agency for Healthcare Research and Quality (AHRQ)-- formerly the Agency for Health Care Policy and Research (AHCPR), launched the National Guideline Clearinghouse (NGC), www.guideline.gov, an Internet-based source of information on clinical care that will help health professionals to improve the quality of care they provide to their patients. The NGC, a resource of evidence-based clinical practice guidelines, was developed by AHRQ in partnership with the American Medical Association (AMA) and the American Association of Health Plans (AAHP). The NGC has logged more than 640,000 visits in its first 10 months, an average of 3,000 to 4,000 per day.

THE PROMISE OF QUALITY, AFFORDABLE HEALTH CARE FOR EVERY WORKING FAMILY

With new proposals to implement a Patients' Bill of Rights and reduce medical errors, 1999 was a milestone in the effort to improve health care quality. Life expectancy and prenatal care increased, while deaths from AIDS continued their remarkable decline. HHS took new steps to reduce health care disparities, by working to improve the programs and services that reach America's minority populations. And Dr. David Satcher released the first-ever Surgeon General's Report on Mental Health, which established conclusively that mental health is an essential component of a healthy life.

Continuing the fight against HIV/AIDS. In October, CDC reported that AIDS fell from the top 15 causes of death in the U.S., declining an estimated 21 percent from 1997 to 1998, a rate of 4.6 deaths per 100,000, the lowest rate since 1987. HIV mortality has declined more than 70 percent since 1995.

The decline in AIDS deaths is in part due to the continuing impact of highly active antiretroviral therapy in helping people with HIV live longer and healthier lives, as well as to our continued efforts to prevent HIV infection in the first place. In 1999, the National Institutes of Health (NIH) conducted studies that found that pregnant women infected with HIV can reduce the risk of transmitting the virus to their infants by about 50 percent if they deliver by cesarean section before going into labor and before their membranes have ruptured.

In addition, a study sponsored by the National Institute of Allergy an Infectious Diseases (NIAID) at NIH, found that a single oral dose of the antiretroviral drug nevirapine (NVP) given to an HIV-infected woman in labor and another to her baby within three days of birth, reduced the transmission of the virus by half compared with a similar short course of AZT. If used and implemented widely in developing countries, this intervention potentially could prevent some 300,000 to 400,000 newborns per year from beginning life infected with HIV.

HRSA awarded $710 million in formula grants to 50 states, the District of Columbia and U.S. territories to improve access to HIV/AIDS primary care, support services and medications for people living with HIV/AIDS and their families. This amount includes $461 million earmarked for state AIDS Drug Assistance Programs (ADAP), which provide financial assistance to purchase HIV medications. HRSA also announced a new $11 million grant program beginning in May 2000 to support four five-year demonstration projects and one evaluation center to provide innovative health care and support services for people with HIV/AIDS living in the U.S.-Mexico border region. The program will serve hard-to-reach, underserved individuals by funding innovative HIV/AIDS programs that help improve access to care.

SAMHSA's Center for Substance Abuse Treatment awarded grants totaling $16.8 million to enhance and expand substance abuse treatment and HIV/AIDS, sexually transmitted diseases, tuberculous, and hepatitis B and C services in 35 African-American and Latino and other ethnic/racial minority communities severely affected by the twin epidemics of substance abuse and HIV/AIDS. This program seeks to address gaps in treatment capacity and increase the accessibility and availability of substance abuse and HIV/AIDS treatment services. SAMHSA also funded an additional 25 community-based organizations for a total of $9.5 million to provide outreach services to substance abusers at risk of contracting HIV. Both of these grant programs were funded under the Congressional Black Caucus Initiative.

In December, NIAID announced renewed funding for the Adult AIDS Clinical Trials Group (AACTG), the largest clinical trials network in the world. Under the new award, the AACTG will receive $80 million in the first year of a five-year grant. The funding enables the network to continue conducting studies of antiviral interventions, methods to reconstitute the immune system damaged by HIV, and the treatment and prevention of opportunistic diseases and other HIV-related complications.

Closing the Gap in Health for Racial and Ethnic Minority Populations. Launched by President Clinton in February 1998, the racial disparities initiative sets a national goal of eliminating major health disparities in six key areas by the year 2010. The administration won a huge victory in this regard in the fiscal year 2000 budget, obtaining an increase of 7 percent, to $2.4 billion in the Indian Health Service (IHS) budget. For fiscal year 2000, HHS has committed $30 million for the second year of CDC's Racial and Ethnic Approaches to Community Health (REACH 2010). Fiscal year 2000 funds will enable communities that are ready to start implementing these plans. Several programs, which have a large effect on reducing racial and ethnic health disparities such as Community Health Centers and Ryan White HIV/AIDS activities, also received increases in fiscal year 2000.

HRSA's Bureau of Primary Health Care launched an ambitious campaign entitled "100 Percent Access/0 Health Disparities," by organizing community groups and key safety net providers in partnerships to address the health care needs of their communities. Local partnerships include public and private providers, hospitals, free clinics and universities. National partners include the Coalition for Healthier Cities and Communities, the American Academy of Pediatrics, and One Church, One Addict. The long-range goal is to build infrastructure to sustain and support communities in providing health care delivery and other social services for underserved residents.

• HIV/AIDS. In response to the severe and ongoing crisis regarding HIV/AIDS in racial and ethnic minority communities, CDC awarded $9.4 million in grants in September to 32 community coalitions in 18 states to help address racial and ethnic disparities. The awards are a component of CDC's new REACH 2010 initiative.

  On September 16, HHS awarded $3.9 million in planning grants to 79 public and private organizations to bolster HIV/AIDS care to African-Americans and individuals in rural and underserved areas. The 79 grants are funded under the Title III Planning Grant Program of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act administered by HHS' Health Resources and Services Administration (HRSA). Sixty of the grants, totaling $3 million, are being awarded as part of HHS' year-old partnership with the Congressional Black Caucus to battle HIV/AIDS in communities of color.

  In June, HHS announced that it would send special teams of experts known as Crisis Response Teams into those communities at their request to meet with local officials, public health personnel and community based organizations that work with racial and ethnic minority persons living with HIV/AIDS. The teams are designed to help communities develop targeted strategies to curb the rapid spread of HIV/AIDS among minority populations in their communities. To date, Crisis Response Teams have been sent to Detroit, Miami and Philadelphia.

• Diabetes. Both the Indian Health Service and HRSA increased their efforts this year to reduce the incidence of diabetes among Native Americans and African-Americans. IHS funds will be used in part to fund grants to Indian communities for programs focused on primary prevention of diabetes and promoting healthy lifestyle choices.

• Immunizations. Immunization rates for the complete series of childhood immunizations has reached a record high of 80 percent, and rates for the most critical vaccines are nearly the same for children of all racial and ethnic groups--closing a gap that was as wide as 26 percentage points a generation ago. In April, Secretary Shalala announced a new Spanish-language childhood immunization public awareness campaign to create and distribute culturally relevant and language appropriate educational materials to help raise Hispanic immunization rates all the way up to the national average. The Spanish-language theme, 'Vacunelo A Tiempe, Todo el Tiempo,' ('Vaccinate Your Children On Time, Every Time'), encourages parents and caregivers to talk with their child health care provider to make sure their child is up to date by age 2. The Spanish-language PSA is narrated by popular Cuban-American musician Jon Secada.

  As for adults, progress is still needed among African-Americans and Hispanics. Among persons aged 65 years or more, influenza and pneumonia were the fifth leading cause of death for African-Americans and Hispanics as well as non-Hispanic whites. CDC's REACH grants provide funding for adult immunization activities aimed at eliminating disparities. Three additional REACH grants will be funded by the California Endowment.

  The Health Care Financing Administration (HCFA) also stepped up its efforts to increase the number of minorities receiving flu and pneumonia vaccinations this year, mailing nearly 8 million postcards in four languages to remind Medicare beneficiaries to get immunized and releasing television and radio announcements in English and Spanish for local outlets to use across the country, including a PSA with African-American gospel star CeCe Winans. HCFA also joined with Medicare's quality-review organizations and historically black colleges and universities to develop strategies for boosting immunization rates among African-American beneficiaries.

• Infant Mortality. On October 26, HHS announced the start of a new component of the successful "Back to Sleep" campaign that will focus on reducing the incidence of Sudden Infant Death Syndrome (SIDS) among African-Americans. The goal of the new initiative, led by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health, is to develop and implement a community-based approach to eliminate the disparity in SIDS rates affecting African-American communities.

• Prenatal Care. Timely prenatal care improved steadily through the 1990s. In 1998, 82.8 percent of women began care in the first trimester of pregnancy, compared with 75.5 percent in 1989.

• Cancer Screening and Management. HCFA and the NCI co-sponsored a national education campaign about the new annual Medicare mammography benefit and the importance of regularly scheduled screening mammograms. The new efforts focus on areas where there is a high concentration of older women. In addition, Secretary Shalala also released two public service announcements featuring singer and actress Whitney Houston and First Lady Hillary Rodham Clinton. Since 1995, both the President and the First Lady have appeared in television public service announcements encouraging older women to get mammography screening and promoting the use of Medicare coverage for mammography.

  In March, a national campaign to educate Americans 50 and older about colorectal cancer --the nation's number two cancer killer--was launched by the CDC, HCFA and NCI. The "Screen for Life" campaign informs Americans 50 and older, the age group most at risk for colorectal cancer, about the importance of screening tests for early detection and prevention of the disease. It was expected that an estimated 129,400 men and women would be diagnosed with colorectal cancer in 1999, and more than 56,000 lives lost to this disease. Many colorectal cancer deaths could be prevented with screening. In part, the campaign aims to encourage Medicare beneficiaries and others to take advantage of colorectal cancer screening, a preventive benefit now covered under Medicare.

  CDC's initiative, REACH 2010, also targets improving breast and cervical cancer screening and management as one of its six health priority areas. The other areas are infant mortality, cardiovascular disease, diabetes, improving child and/or adult immunization levels and HIV/AIDS.

• Cardiovascular Disease. In September 1999, the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of NIH issued a statement to alert physicians, patients, and the public to the increasing importance of diabetes mellitus as a major risk factor for cardiovascular disease. The alert was prepared in collaboration with three leading private health organizations. Cardiovascular complications are now the leading causes of illness and death in the diabetic patient. The increasing prevalence of type 2 diabetes, the most common form of the disease, is related to a variety of factors including the rapid growth in the U.S. of populations that are particularly susceptible to the type 2 form: African-Americans, Hispanics, Native Americans, Pacific Islanders, and Asians. The statement emphasized that both cardiovascular disease and type 2 diabetes may be prevented by lifestyle changes that maintain normal weight and physical activity.

• Much of what we know about the cardiovascular complications of diabetes has come from studies supported by these two institutes. This year, they began two large clinical trials designed to identify ways to reduce these complications. One study will evaluate the benefits of intensified control of high blood sugar, cholesterol and hypertension. The other will focus on the benefits of weight loss in obese diabetics.

Health Care Worker Safety. The National Institute for Occupational Safety and Health (NIOSH) in CDC worked with diverse partners in industry, the health care community, labor, government, and public health to reduce job-related injuries and illnesses among the nation's eight million health care workers. By improving the quality of working conditions for this vital and growing workforce, these initiatives improve the quality of U.S. health care. For example, on November 22, NIOSH issued recommendations to prevent job-related needlestick injuries among health care employees. Six-hundred thousand to 800,000 such injuries are estimated to occur every year and can lead to serious or potentially fatal infections with bloodborne pathogens. NIOSH also continued to work with diverse partners on further research and risk communication for preventing allergic reactions due to job-related exposures to natural rubber latex in gloves and other products. Studies indicate that 8 to 12 percent of health care employees regularly exposed to latex are sensitized, compared with 1 percent to 6 percent of the general population.

Patients' Bill of Rights. On November 8, HHS announced a proposed regulation that will extend patient protections to all children enrolled in SCHIP. This proposed regulation is consistent with President Clinton's 1998 Executive Order that all federal health plans collectively covering over 85 million Americans should come into compliance with the Patients' Bill of Rights. The protections include access to health care specialists, access to emergency services when and where the need arises, an assurance that doctors and patients can openly discuss treatment options, and access to a fair, unbiased and timely appeals process.

In June, HCFA announced new patient protections in standards to protect the health and welfare of hospitalized patients. The patients' rights regulations strengthen existing protections for patient health and safety and will help assure that high quality care is provided to all patients in hospitals participating in the Medicare and Medicaid program. The six basic patient rights specified in the regulations include the right to confidentiality of patient records and communications, and the freedom from the inappropriate use of restraints and seclusion.

Reducing Medical Errors. On December 7, President Clinton issued an Executive Memorandum directing the Quality Interagency Coordination Task Force (QuIC) to develop new strategies to improve health care quality and protect patient safety. The President also announced that each of the more than 300 private health plans participating in the Federal Employee Health Benefits Program will be required to institute quality improvement and patient safety initiatives. HHS and other federal agencies that administer health plans were asked by the President to evaluate, and where feasible, implement the latest error reduction techniques.

Improving the Safe Use of Pharmaceuticals. AHRQ launched the Centers for Education and Research on Therapeutics (CERT), a $7.7 million project to improve the quality of health care and help reduce risk of adverse drug events. The centers will conduct state-of-the-art clinical and laboratory research on new uses of drugs, biological products and devices; ways to improve their use; and the risks of new uses and risks of combinations of drugs and biological products. The CERT demonstration program was authorized by Section 409 of the FDA Modernization Act of 1997. AHRQ's reauthorization legislation made it a permanent initiative of the agency.

The Surgeon General's Report on Mental Health. On December 13, HHS released the first ever Surgeon General's Report on Mental Health, which emphasizes the importance of mental health as an essential component in leading a healthy life. Our understanding of mental health and illness has dramatically improved the way in which mental health care is provided. Safe and effective options are available to treat the mental disorders that affect one in five Americans per year. The report urges Americans to take advantage of this tremendous growth of scientific knowledge by seeking treatments for mental disorders, which affect one in five Americans. The report also emphasizes the importance of bringing this often hidden topic out into the open, and notes that disorders such as depression, schizophrenia, alcohol and drug addiction, and eating disorders are real illnesses that, if untreated, can be as disabling and serious as cancer and heart disease in terms of premature death and lost productivity.

EXPANDING HEALTH CARE COVERAGE

This year, we also took a number of steps to increase Americans' access to health care. We worked with states to increase the availability of Medicaid, particularly to young adults leaving the foster care system; and made it easier for children to get health insurance through their non-custodial parents after a separation or divorce. We obtained initial funding for a new initiative that complements these efforts by increasing health care access for uninsured workers. And we completed the approval of the State Children's Health Insurance Program (SCHIP) in all 56 states and territories in the country, extending health care coverage to millions of uninsured children.

Improving Health Care Access for the Uninsured. In fiscal year 2000, HHS will begin two new initiatives to improve health care access for the uninsured. The first initiative seeks to increase the capacity and effectiveness of the nation's health care safety net. Through a competitive grant program, communities will receive funds to support infrastructure and other improvements and to provide additional health care services. In fiscal year 2000, $25 million has been provided to fund 10-20 grants. In fiscal year 2000, $15 million has also been appropriated for a new initiative to support up to 10 grants to states to develop designs for providing access to health insurance coverage to all residents of the state.

SCHIP Expansion. In 1999, HHS worked diligently with the states to develop and implement plans to extend health care coverage to millions of uninsured children. On September 8, 1999, HHS announced that the State Children's Health Insurance Program (SCHIP) had been approved in all 56 states and territories in the country. Under the federal SCHIP program, the historic legislation signed into law by President Clinton in 1997, more than $24 billion has been appropriated for the first five years of the program to help expand health insurance to children whose families earn too much to qualify for traditional Medicaid, yet not enough to afford private health insurance.

Medicaid and SCHIP Outreach. In October, President Clinton announced new federal efforts to identify and enroll the millions of uninsured children who are eligible for Medicaid and SCHIP. These efforts included directing cabinet secretaries to develop strategies to integrate children's health insurance outreach into schools; sending new guidance to states and schools on funding options for school-based outreach; and dedicating more than $9 million over three years in research funds through a public-private partnership to identify effective children's health insurance strategies.

To help state and local outreach efforts, President Clinton and HHS, along with the National Governors' Association, launched the Insure Kids Now Hotline, 1-877-KIDS-NOW, and the Insure Kids Now Web site at www.insurekidsnow.gov. The Insure Kids Now Hotline is a national toll free number that parents or other interested persons can call for information about free or low-cost health insurance for their children. The Insure Kids Now Web site also offers information on children's health insurance coverage in each state or territory, information on how to apply for coverage, and guidelines for whether families might qualify for a plan.

HHS also proposed expanding the high performance bonuses authorized under the 1996 welfare reform law to reward states that meet increased enrollment of eligible children and families in Medicaid and SCHIP.

Expanding Children's Access to Private Insurance. On November 15, HHS announced a proposed rule to make it easier for children to get health insurance coverage through their non-custodial parents. The regulation creates a standard form to enforce child support agreements that require non-custodial parents to provide for their children's health care needs.

Improving the Quality of Care for Low-Income Children. AHRQ, the David and Lucile Packard Foundation, and HRSA joined to fund a set of research studies to help public health insurance programs and health care delivery systems improve the quality of, and access to, health care for low-income children. Overall funding will total $9.1 million over three years for nine research projects. President Clinton announced the award at a White House event in October.

SUPPORTING INDEPENDENT LIVES IN THE COMMUNITY FOR PEOPLE WITH DISABILITIES

The Department has continued its uncompromising support of health, long-term care, and social support programs and policies to ensure that the over 40 million Americans with disabilities are able to experience independent, high quality lives in the community.

The Ticket to Work and Work Incentives Improvement Act of 1999. On December 17, President Clinton signed landmark legislation making it possible for millions of Americans with disabilities to join the workforce without fear of losing their Medicaid and Medicare coverage. It also modernizes the employment services system for people with disabilities. This legislation creates new options for states to offer a Medicaid buy-in for workers with disabilities:

• Provides $150 million in grants to encourage states to take this option;
• Creates a new $250 million Medicaid buy-in demonstration to help people whose disability is not yet so severe that they cannot work;
• Extends Medicare coverage for an additional four-and-a-half years for people in the disability insurance system who return to work; and enhances employment-related services for individuals with disabilities through the new "Ticket to Work" program; and
• Creates a new $250 million demonstration program that tests whether early medical intervention, made possible through an affordable Medicaid benefit, will enable people with early symptoms of HIV, muscular dystrophy, Parkinson's Disease, or diabetes to stay healthier and keep working.

HHS has showed strong support for the Americans with Disabilities Act (ADA), most notably through rigorous enforcement by the HHS Office for Civil Rights. Secretary Shalala has also expressed her support for the Supreme Court's decision in the Olmstead v. L.C. case; the court found that the ADA requires states to administer their programs, including their Medicaid long-term care programs, in the most integrated setting possible. Secretary Shalala has expressed her interest in assisting state Medicaid programs in their efforts to comply with the ADA.

Multiple initiatives and programs have come about as a result of Secretary Shalala's strong commitment to partner with states to expand and promote home and community-based services.

• HHS provided funding for eight states to participate in the nursing home transition program. Through this grant program, states are assisting nursing home and other institutional residents to move into community-based settings, using grant funds to cover a range of expenses not typically covered by other programs.
• The "Cash and Counseling" demonstration continues, enabling people with disabilities to have more control over their personal assistance services, by hiring, training, and managing their own assistants.
• In 1999, HHS established a Home and Community-Based Resource Network, to support states and consumers in their collaborative efforts to plan and implement systems to increase home and community-based services options for people with long-term care needs.

THE PROMISE OF A RETIREMENT WITH DIGNITY FOR ALL AMERICANS

With the number of seniors doubling by the year 2030, providing proper care of our aging citizens will be one of the central challenges of the 21st century. We must ensure that living a long life also means enjoying a good life. That's why HCFA worked hard this year to improve customer service; joined with the Inspector General to fight waste, fraud and abuse; and toughen federal and state enforcement of nursing home standards. Marking the International Year of Older Persons, the Administration on Aging (AoA) organized new strategies to address the aging of our population and increased its investment in meals on wheels and consumer education. Of course, the cornerstone of our commitment to a retirement with dignity is Medicare. To ensure that the promise of Medicare is never broken, President Clinton has challenged this Congress to earmark one of every six surplus dollars for Medicare over the next 15 years, provide a much-needed prescription drug benefit, and enact competitive reforms in the program.

Improving Nursing Home Quality. AoA and HCFA joined forces to improve the quality of care in nursing homes by awarding $450,000 to four national aging organizations in the fall of 1999. The awards, part of the Clinton administration's initiative on nursing homes, will support the demonstration of approaches to educate and empower communities and families to improve nutrition, hydration and prevent abuse of nursing home residents.

On December 14, HCFA announced that nursing homes that fail to protect residents from harm will face immediate penalties and consumers will have access to more information about the quality of nursing-home care. HCFA instructed states to impose immediate sanctions, such as fines, against nursing homes in more situations, including any time that a nursing home is found to have caused harm to a resident on consecutive surveys. HCFA also:

• Increased states' flexibility to encourage speedier action to stop payments for new admissions and to impose other sanctions when nursing homes violate federal health and safety requirements.

• Enhanced Nursing Home Compare, its consumer Internet resource found at www.medicare.gov, to include information about the prevalence of bedsores, weight loss and other health conditions among residents in individual nursing homes.

• And updated its "Guide to Choosing a Nursing Home" to take families and friends step-by-step through the process of identifying an appropriate home for a loved one.

Fighting Health Care Fraud, Waste and Abuse. In June 1999, AoA awarded 41 grants totaling $7 million to expand a program that recruits and trains retired professionals to identify waste, fraud and abuse in the Medicare and Medicaid programs. The Senior Medicare Patrol Project grants, including 29 new and 12 renewed grants, were distributed among 36 states, the District of Columbia, and Puerto Rico. The grant funds will be used to teach volunteer retired professionals such as doctors, nurses, accountants, investigators, law enforcement personnel, attorneys, teachers and others how to work with Medicare and Medicaid beneficiaries. Volunteers work in their own communities and in local senior centers to help identify deceptive health care practices, such as overbilling, overcharging, or providing unnecessary or inappropriate services.

In February, the HHS Office of Inspector General reported that improper Medicare payments to hospitals, doctors and other health care providers declined dramatically last year to the lowest error rate since the government initiated comprehensive audits three years ago. The error rate for fiscal year 1998 was an estimated 7.1 percent, nearly a 50 percent drop from the 14 percent error rate reported in fiscal year 1996.

Earlier this year, HCFA announced 12 new specialty contracts to investigate special aspects of waste, fraud and abuse including community mental health centers, specific fiscal intermediaries, and corporate integrity agreements. Further expanding the Clinton administration's campaign against waste, fraud and abuse, HCFA also announced a new contract to help Medicare increase the roughly $3 billion saved each year by ensuring that private insurance companies pay their share of Medicare beneficiaries' health care bills. By consolidating these efforts into a single contract, HCFA also expects to improve service to Medicare beneficiaries, health care providers, insurance companies and employers.

Improving Medicare Customer Service. On March 15, HCFA announced the new National Medicare+Choice toll-free telephone line, 1-800-MEDICARE (1-800-633-4227). This nationwide phone line gives Medicare beneficiaries--and those who help them make health care decisions--one more tool to get help with their questions about Medicare and their Medicare health plan options. HCFA also created and launched a new and much more user-friendly billing statement and award-winning Medicare-Compare Web site at www.medicare.gov. The statement was developed with input from focus groups and from senior organizations.

To ensure that Medicare beneficiaries have access to the latest effective, evidence-based treatments, HCFA announced in April that it has established a new process to make national coverage decisions more open, understandable and predictable. This new process outlines procedures on how the public may request national coverage decisions as well as timelines for reviewing requests and the roles of HCFA staff, the Medicare Coverage Advisory Committee and technology assessments in national coverage decisions.

In the fall of 1999, Medicare conducted the first national mailing of the "Medicare and You" 2000 handbook to more than 34 million beneficiary households. The handbook reflected improvements suggested by beneficiaries, advocates and members of Congress.

Home Delivered Meals Program. For fiscal year 2000, AoA received a 31 percent budget increase in the Older Americans home-delivered meals program, an increase to $147 million, which will provide 27 million additional meals to home bound elders.

International Year of Older Persons. The World Health Organization recognized HHS as the only national health department to have organized a collaborative cross-departmental response to the International Year of Older Persons. AoA, as head of the Federal Committee for the International Year for Older Persons, convened a symposium of nearly 300 senior administrators from across the executive branch of the federal government to address policy and program implications of our rapidly aging society. The federal committee will continue to meet to review symposium suggestions for interagency collaboration.

CONTINUING PROGRESS ON WELFARE REFORM

Since 1993, the Clinton administration has worked hard to help states reform the welfare system. This year, new findings were released showing that there have been real results in helping welfare recipients leave welfare, enter the workforce, and succeed on the job. New job retention rates and earnings increases, in particular, now demonstrate that there are promising strategies for helping low-income parents make the transition from dependence to self-sufficiency. And HHS took new steps to improve state performance by awarding the first high-performance bonuses, out-of-wedlock birth bonuses, and grants for Individual Development Accounts.

States Rewarded for Successfully Moving People from Welfare to Work. Twenty-seven states received high performance bonuses totaling $200 million in December for excellent performance in moving welfare recipients into jobs. The performance bonus program was authorized by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which made available a total of $1 billion over five years. The states placed 1.3 million welfare recipients into new jobs in 1998. Of these 80 percent retained their jobs three months after being hired. In addition, their earnings rose from $2,100 in the first quarter of employment to $2,650 in the second.

Record Results. On August 2, 1999, HHS reported that all 50 states and the District of Columbia met the overall work participation rates for all families in 1998, the first full year of the new welfare reform law. Welfare caseloads are at their lowest level since 1967 and the welfare rolls have fallen by nearly half since 1993. Nationwide, the rolls have fallen by 51 percent, from 14.1 million to 6.9 million.

States also reported a new record percentage of parents on welfare that are working. Data released in 1999 shows that 35 percent of all welfare recipients were working, looking for employment or enrolled in education and training in 1998. The percentage of employed recipients reached an all-time high at 23 percent, compared to less than 7 percent in 1992 and 13 percent in 1997. Similarly, the proportion of recipients who were working, including employment, work experience and community service, reached 27 percent, a nearly fourfold increase over the 7 percent recorded in 1992.

"Assets for Independence" Demonstration Grants. In September 1999, HHS announced the first award of $9.4 million for 40 demonstration grants under the Assets for Independence Demonstration Program. These new five-year projects will provide federal funds to match the amount of earnings that low-income working individuals and families put into savings for a first home; post-secondary education; or to start a new business. Since 1993, the Clinton administration has supported the creation of Individual Development Accounts (IDAs), which empower low income Americans to save and build assets for their futures. The 1996 welfare reform law encouraged states to use their federal welfare block grants to establish IDAs. Since then, 29 states have included IDAs as part of their welfare reform plans.

States Receive Bonuses in Reducing Out-of-Wedlock Births. HHS awarded $100 million in new bonuses to four states and the District of Columbia for achieving the nation's largest decreases in out-of-wedlock births between 1994 and 1997. This was the first award of the bonuses for reductions in out-of-wedlock births, as provided for in the welfare reform law of 1996. The awardees, Alabama, California, the District of Columbia, Massachusetts and Michigan, each received $20 million.

###

Note: For other HHS Press Releases and Fact Sheets pertaining to the subject of this announcement, please click here (www.hhs.gov/news/press/) for our Press Release and Fact Sheet search engine at: www.hhs.gov/news/press/.