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REMARKS BY: DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: Fiscal Year 2000 Budget Press Conference, Washington, D.C. DATE: February 1, 1999

Fiscal Year 2000 Budget

Over the last seven years, I've often been asked how we even begin preparing a budget for a department as large and diverse as Health and Human Services. And what I've said is that as strenuous as it is, we've always been successful because all of us here are guided by one goal: Crafting a budget that honors America's values without breaking America's bank. And that's exactly what this budget does. But while the choices we made were hard headed, they weren't cold hearted. In essence, what this budget does is help keep some very important promises to our nation's families:

In short, it's about keeping faith with the President and Vice-President's vision of a 21st Century America where every family can get ahead, and where none of us is ever left behind.

With outlays of $400 billion, the Fiscal Year 2000 budget is just 6.6 percent above last year's budget of $375.5 billion. But the real story is how much we plan to achieve, and how many promises we plan to keep, within the balanced budget framework. This is especially true when it comes to meeting the needs of older 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. Our long-term care initiative will help us meet that challenge.

This initiative is designed to help 2 million Americans, most of them older and severely disabled. As most of you know, the crux of the plan is to provide a $1,000 tax credit for people with long-term care needs or their family caregiver.

Let me be clear, this initiative won't just help older Americans-it's also central to our strategy to help Americans of all ages who are disabled. And this initiative isn't just about financial assistance-it's about providing comprehensive assistance to those giving or needing long-term care.

That's why our long-term care initiative also includes a $125 million investment by our Administration on Aging in the new, "National Family Caregiver Support Program" to provide assistance to people caring for elderly or disabled family members. And we're proposing a five-year, $110 million expansion of our Home and Community-Based Care options program to help expand alternatives to institutional care. But our long-term care initiative doesn't stop there.

At HCFA, we'll be launching a $10 million national campaign to help inform and educate Medicare beneficiaries about their own long-term care options. This will give them the information they need to make sense of their new health care choices. We're also calling for an increase of more than 31 percent in home delivered meals.

But there are 1.6 million other elderly and disabled Americans our initiative speaks to. They're the Americans living in our nation's nursing homes. That's why our budget provides $60 million to fully implement the Health Care Financing Authority's nursing home quality initiative. We're going to toughen federal and state enforcement of nursing home standards, and ensure that second-rate nursing home care becomes part of this country's past, not part of its future.

Of course, the cornerstone of our commitment to a retirement with dignity is Medicare. To ensure that the promise of Medicare is never broken, last month President Clinton challenged this Congress to earmark one of every six surplus dollars for Medicare over the next 15 years.

Here at the Department, we're moving ahead to strengthen and modernize Medicare today. Over the last six years, we've reinvented HCFA. We've transformed it from an agency that simply paid the bills into a prudent purchaser of health care. We've set tough, new quality and patient protection standards. We've helped our customers to understand the new choices available to them. We've provided new or expanded coverage for prevention services ranging from mammograms to bone density screening.

And this budget provides $165 million-$150 million of it going to HCFA-to ensure that all of our computers are immunized against the Y2K bug.

We're also doing one more thing: We're fighting a real war on waste, fraud and abuse. Woody Guthrie once wrote that some men will rob you with a six gun, and others with a fountain pen. At the Department, we've instituted a "zero tolerance" policy against those who rip-off the taxpayers by filing false Medicare and Medicaid claims.

That's what Operation Restore Trust was all about. And that's why we've reached out to hospitals, home health agencies, labs, and health professionals-and to our older Americans themselves- to train them how to spot fraud and where to report it. And that's why this budget proposes a legislative package to fight fraud, waste and abuse that will save Medicare $2.9 billion over five years.

And by reducing excessive reimbursements to providers and initiating other reforms that reflect marketplace changes, we'll be able to save Medicare an additional $6.5 billion over these next five years. Our action agenda doesn't end with helping vulnerable Americans live with dignity. That's only where it begins.

This budget also speaks to the needs of America's working families. In particular, it addresses the needs of the 24 million working Americans, many of them over 55, whose jobs provide a paycheck-but not health insurance.

For many years, government has been too willing to shrug its shoulders and walk away from these workers. This Administration has a better idea. We again propose that uninsured workers ages 62 to 65 be allowed to buy into Medicare. We also want all other Americans ages 55 to 62-who have lost their jobs and health insurance through no fault of their own-to have a similar option. In addition, we want to make sure that employers who've denied promised health benefits to retirees 55 to 65 are made to keep their promises. Complementing these proposals is a new initiative to provide health care access for uninsured workers. It would invest $1 billion over the next five years to help community health clinics, public hospitals, and academic health centers create new systems of coordinated and comprehensive care for uninsured workers.

For example, we're talking about new systems to help providers to share patient records and improve the quality of care. That's a small investment, but it's one that will pay enormous dividends. Think of it as "glue money" to help communities transform what is often ad hoc health care into more durable networks that uninsured workers-and their families-can depend on.

What this is really about is helping uninsured Americans get the right care, at the right place, at the right time. With a system of coordinated care, our working-but uninsured-citizens won't have to wait until they have a life-threatening illness before seeking medical care in our nation's emergency rooms.

This new funding would complement both our new initiatives and our on-going support for community health centers and public health clinics. For example, this budget includes a $100 million increase for Ryan White treatment activities for uninsured Americans infected with HIV. And it reaffirms our commitment to mental health, with a $70 million increase-a 24 percent boost-in the mental health block grant.

Of course, there are some other working Americans who need our help. They are the men and women with disabilities who could join the workforce today, except for the institutional barriers that stand in their way.

Today, almost 75 percent of working-age Americans with disabilities are unemployed. One of the main causes has been their inability to keep their Medicaid benefits once they re-enter the workforce. To help these Americans so they can help themselves, this budget allows the Health Care Financing Authority to provide new options for disabled workers to purchase heath care coverage through Medicaid.

We also can't forget that too many of our citizens face a higher risk of illness and death for only one reason: The color of their skin. For example, African-Americans have an infant mortality rate that remains more than twice that of Caucasians. And American Indians and Alaska Natives are more than three times as likely to die from diabetes, as are other Americans.

In this nation, being a member of a minority group shouldn't be hazardous to your health. And that's why our budget allocates almost $5 billion for health education, prevention and treatment services specifically targeted to minority Americans. That includes $145 million for our racial health disparities initiative-an $80 million increase over last year.

What's more, this budget provides the Indian Health Service with $2.8 billion, including $2.2 billion for clinical, preventive and environmental health programs. That's a $170 million increase over last year. And we're changing the Medicaid reimbursement rate, which will infuse another $82 million into Indian Health Service hospitals.

As HHS Secretary, I believe we also have promises to keep with our most irreplaceable citizens-our children. Guaranteeing the safety and health of their children is every parent's first priority. It must be our first priority, too.

Last year I told you that the President's child care initiative is at the crux of this Administration's promise to working families. That was true then-it's true now. As I've said before, by providing $20 billion over five years, this initiative will help answer the three toughest child care questions facing working parents today: Can I get it? Can I afford it? Can I trust it?

This initiative responds by dramatically increasing the availability of child care for working parents. It responds by providing grants to states to help these parents. It responds by investing in health and safety to ensure high quality child care. And as the President announced, our effort also includes a $6.3 billion child care tax credit over five years-with $1.3 billion earmarked to help moms or dads who stay home with their children. But that's only where our initiatives for children begin.

Our budget includes a $1.2 billion, five-year, outreach initiative to inform eligible families about our Children's Health Insurance Program and Medicaid services. In addition, we're giving states the opportunity to expand Medicaid coverage to protect more children and pregnant women.

We're also proposing $50 million in grants to states to test new asthma management techniques for children covered by Medicaid. And we've budgeted $40 million to support graduate medical education at America's children's hospitals. But our efforts aren't limited to helping only the very youngest.

Each year, 20,000 young Americans will "age-out" of foster care once they turn 18. But too many of them are still unprepared to meet the challenges of adulthood. That's why this budget will help these young people gain the basic skills they need to survive in the grown-up world, including the workplace. And why we've earmarked funding for the transitional living program for homeless and runaway youth.

But to help them transition from supervision to independence, we must also guarantee that foster children get the health care they need, through Medicaid, until they turn 21. With an allocation of $45 million over five years, that's exactly what this budget will begin to do.

Of course, it's impossible to talk about children's health without also talking about tobacco. Each day 3000 American kids become regular smokers and 1000 of them will live shorter lives as a result.

In his State of the Union Address, the President talked about our battle to protect America's children from tobacco. Here at the Department, we'll be fighting to save those lives. First, for Fiscal Year 2000, we'll be allocating $61 million of additional funds to combat children's tobacco use. $34 million will go to the FDA's outreach and enforcement programs, and $27 million will be used to expand CDC's state-based prevention activities. And we'll be working once again to give the FDA the authority it must have to effectively regulate tobacco products. The President already announced that the Justice Department is preparing a litigation plan to take tobacco companies to court.

Let me be very clear: This Administration is out to hold tobacco companies accountable, and to see to it that no one breaks the law and sells cigarettes to our children-ever again.

It's all about protecting the health of America's kids. And so is childhood immunizations. Thanks to the Administration's childhood immunization initiative, the incidence of diphtheria, tetanus and measles among children is at a historic low. And immunization rates are at an all-time high. But we can't afford to rest on our laurels.

We need to keep the pressure on and ensure that getting vaccinated by age two is as much a part of childhood as getting your first tooth. That's why we've allocated $1.1 billion to CDC for childhood immunization.

And, perhaps most significant of all, this budget reaffirms the President's long-standing commitment to Head Start. This isn't the old Head Start. It's been reinvigorated with an added focus on kids age zero to three. And we're creating full-time, full-year programs in partnership with the private sector. With the $5.3 billion we've set aside for this program, we'll be able to increase the number of participating children by more than 42,000 in the year 2000. In the process, we'll be nurturing young minds at the time they need it most.

When we talk about our fight against tetanus and polio - or about innovative new treatments for asthma - we're not simply talking about policy, but about science. Science that can improve lives. Science that can save lives.

That's always been an essential part of our mission at the Department-and with this budget, it will continue to be, but with a new focus on bolstering our public health infrastructure.

Our budget proposes investing $65 million in developing and implementing a national electronic disease surveillance initiative at CDC. Once in operation, this network will create a critical link to help us better track influenza, food-borne illness and other infectious diseases.

With this new budget, FDA funding will increase by 19 percent to $1.35 billion: The largest funding increase in two decades. And it includes a $30 million-60 percent increase-for its food safety programs. These funds will guarantee FDA the resources it needs to ensure that important drugs, medicines and food additives are carefully - but efficiently - reviewed. They will allow the FDA -- America's toughest consumer watchdog -- to do an even better job challenging defective products.

At the National Institutes of Health, this new budget means an increase of $320 million to carry out essential biomedical research to prevent and combat diseases like Alzheimer's and AIDS. This is another critical installment in the President's five-year commitment to increase NIH funding by 50 percent.

And under this budget, we are again proposing that Medicare patients participate in cancer clinical trials. This will help bring effective, new cancer treatments into the mainstream of American medicine.

Finally, as we enter the 21st century, America will need to guard against complacency over all infectious diseases - and not just the random outbreak. We must now guard against willful acts of bioterrorism.

This department has a vital role to play. Because bioterrorism is not just a problem for the military or for law enforcement, it's a problem for the entire health community. That's why this budget proposes a $72 million increase for medical and public health response and preparedness for bioterrorism. This amount will allow us to expand research on biological and chemical agents, to improve surveillance, and to support local medical response systems.

With the threat of bioterrorism knocking at our door, we can't afford to be caught off guard. Dustin Hoffman may be able to single-handedly save America from a deadly disease in a Hollywood movie, but, in real life, it takes a few more of us-in communities all across this country.

In closing, let me tell you about one of the things I'll always remember about growing up in Cleveland. It's how so many people - from so many different parts of the world - managed to make their way to that one city. They were people like my grandfather-Khalil Shalala-who came to Cleveland from Lebanon exactly 100 years ago.

He came looking for work. But, even more than that, he came looking for his one, small piece of the American dream: He wanted the chance to lead a healthy life. He wanted the opportunity to retire with dignity. He wanted the prospect that his kids-and grandkids-could have a happier, healthier, safer childhood than he ever had. He wanted the possibility of becoming part of the most prosperous most advanced nation on earth.

That was the promise of America throughout the 20th century. That's still the promise of America today. And with the initiatives President Clinton presented - initiatives this budget proposes - we'll continue working to keep that promise as we enter a new century.