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Office of the Press Secretary

For Immediate Release February 20, 1997
                        REMARKS BY THE PRESIDENT
                          ON MEDICAID GAG RULE

The Oval Office

11:05 A.M. EST

THE PRESIDENT: Thank you. I was just sitting here thinking that in the spirit of full disclosure the Vice President and Secretary Shalala may have a particular vested interest in health care issues -- that they both just got back from South Africa and when they got back he got on a plane and went to Los Angeles to speak to the AFL-CIO convention; he got back at 4:00 a.m. this morning. And she got on a plane and went to New York with me to a welfare reform event. And I don't see how either one of them are still standing up. (Laughter.) But they probably have a strong interest in what happened here today.

Let me thank, if I might, first of all, all the members of Congress who are here from both parties for their leadership on this issue; and Bruce Vladeck and Bruce Reed for what they have done; and the representatives of the groups over here to my right for being here and for supporting our endeavors.

Today I'm pleased to announce that we're taking steps to see that Medicaid beneficiaries continue to get access to the fullest quality health care. In recent years, the medical community and the insurance industry have joined to reform and improve American health care, working with us, and much of this progress has come through managed care, which emphasizes prevention, provides better care, and controls costs at the same time, when the plans are the best and the right kind of managed care plans.

On the whole, the growth of managed care has been a good thing for our country. But we also know, we've seen enough to know that we have to make absolutely sure that this rapid transformation does not lead to a decline in the quality of health care.

That's why I've been concerned about these so-called gag rules that some HMOs and other health care plans have -- rules that restrict the ability of health care professionals to administer proper medical care, that prevent doctors and nurses from telling patients about alternate and sometimes more expensive care that are not covered by the plans that they're in. This is unacceptable. Patients in HMOs and other health plans should know that they're doctors will give them the very best information, the very most complete information, the widest possible range of information when it comes to their treatment. And there shouldn't be a shadow of doubt about this.

In December, as Secretary Shalala just said, we took action to give Medicare beneficiaries to the right know about their treatment options. Today we take the next step -- acting to protect 13 million Medicaid beneficiaries -- children, the disabled, elderly Americans. I'm directing Secretary Shalala to inform all state Medicaid directors that it's illegal for health care plans to prohibit doctors from discussing any treatment options with their patients. Families facing illness simply should not have to worry that the doctor they trust does not have the freedom to tell them what they need to know. Patients have the fundamental right to know they are getting the best medical treatment, not simply the cheapest.

And this must be only the beginning. We can act today to protect Medicare and Medicaid beneficiaries because they are federal programs and because government is the largest purchaser of managed care in our nation. But to protect 130 million Americans enrolled in managed care throughout the private sector, the Congress must act.

That's why I'm so pleased that members of Congress from both parties, led by those who are here with us today in the House, have come together with the support of doctors, nurses, health care professionals, and consumers to craft legislation that will ban all gag rules for all Americans in all HMOs and other health care plans. I urge the Congress to send me this legislation, and when they do I will promptly sign it into law.

The bipartisan legislation shows how we can work together as we continue step by step to give more families access to quality, affordable health care. I hope we can build on this record of accomplishment and that Congress will join me to pass a balanced budget that extends health care coverage to children, helps people who temporarily lose their jobs to keep their health insurance, covers through Medicare assistance for families with Alzheimer's victims, and provides for annual mammograms, and that reforms Medicaid for the next decade. Today, we built a strong foundation for the health of American families and we can now make sure that it lasts for a long time.

Now, let me close again by thanking these members of Congress who are here and saying that while we have done the right thing for Medicare and Medicaid, we need their legislation to do the right thing for the majority of our fellow citizens who are now covered by private managed care plans.

Q Where lies the fault, the insurance industry?

THE PRESIDENT: Well, I think -- what I think is we're going to have a continuing tension between the need for controlling costs and competition and managing health care, and the need to make sure that you don't shortcut the quality of care, which has been the hallmark of our medical care in America for those who had access to it.

And what we are trying to do, and I think what there members of Congress are trying to do, is to strike the right balance -- to permit managed care to go forward and even to flourish, but to try to set the conditions in which it will operate so that we guarantee that quality of care is not sacrificed.

Q Mr. President, how serious of a blow is it that Mexico's drug czar has been arrested, given the fact that so much of the illegal drugs coming into the United States comes through or originates in Mexico?

THE PRESIDENT: Well, I would -- I think that the American people should have two reactions: first of all, that this is a very serious revelation and deeply troubling; secondly, the fact -- we should be encouraged by President Zedillo's determination because the government has taken this action, the President has personally taken this action, and they've made it public. And they're obviously saying to the world and to the people of Mexico, we will not tolerate corruption if we can find it and root it out, even if it's at the highest level.

So I'm troubled by it, but I'm also encouraged by the strong action President Zedillo has taken. And you may be sure that this will continue to be at the top of our agenda, and when we meet in the not-too-distant future, we will talk more about it. But we've worked very hard with Mexico. And the more success we had in South America in shutting down routes, particularly airplane routes and, to some extent, overland -- routes over water, the more these operations have moved into Mexico, which is a big country with a lot of opportunities, to find places that are sparsely populated to set up these transit operations and, to some extent, processing operations. So we have to have Mexico's cooperation.

And this is a serious thing. I regret it, but, on the other hand, I'm very encouraged that President Zedillo has moved promptly and aggressively to deal with the situation.

Q Have you made a decision on certification?


Q Have you made a decision on certification?

THE PRESIDENT: I have not, and I have not made -- I don't believe I've been given a recommendation yet by the Secretary of State on it.

Q Mike McCurry said today, following on that last question, that this incident would be a factor in the decision whether or not to certify. Why will it be a factor, and how so?

THE PRESIDENT: Well, first of all, let me reiterate, there is a process for doing this that has not been completed, and I have to get the recommendation first. But as I say, as a factor in the certification decision, I would imagine it is a mixed factor. On the one hand, it's troubling because we knew and it's been widely reported that local police organizations at various places in Mexico are highly vulnerable to all the money that was being thrown at them from the drug lords. And the military had been thought to be an antidote to that, a counter-weight. So it's troubling.

But on the other hand, I'll say again that they have not fooled around with this. When the President discovered it, he's taken strong action. It's been very public. It's been non-apologetic. And so I'm encouraged by that. So I would think that this would cut both ways on the certification question.

Q Mr. President, do you see any change in policy with China now that Deng is dead?

THE PRESIDENT: We expect basic continuity here. The Chinese, perhaps mindful of some of the problems they've had in their long history in transitions -- Deng Xiaoping set in motion a process which has been well underway for more than two years now. So -- and I think that that is something that we can all appreciate, that there has been a basic continuity there.

So I think that our policy is the right policy. We will continue to engage strongly with China. I look forward to all the meetings which are going to occur, including Secretary Albright's trip and then the Vice President's trip later, and then the exchange of visits by the two Presidents. The policy we are following of engaging with China, to work where we agree and to honestly air our disagreements and work through them, is the right policy for the people of the United States and, indeed, for the world in the 21st century. If you imagine what the world will look like 30 years from now, 40 years from now, we can do nothing other than what we are doing. It is the right thing to do.

Let me just make one other comment here, because this came up at the last press briefing I had, about the status of our nominations for the Cabinet and the Senate. I have been gratified by the treatment that the Cabinet members who have been confirmed have received by both parties, and the prompt dealing with their nominations. I said something about Mr. Lake when I last was with the press.

The only other comment I want to make today is there has still not been a hearing scheduled for Alexis Herman. I think that is a big mistake. She enjoys wide support among labor -- the labor unions endorsed her yesterday strongly -- and she has wide support among business. I don't know that there's ever been a person nominated for Secretary of Labor that had as much broad support in the business and the labor communities. She's clearly well-qualified. If anybody wants to vote against her for whatever reason, they're plainly free to do that, but she deserves a hearing and if she gets a hearing, she's going to be confirmed. And I think Senator Jeffords is a good man and a fair man, and I believe he will give her a hearing. But it's imperative that it be done. It's now midway through February and I think it's time to get on with this.

Thank you.

END 11:15 A.M. EST