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THE WHITE HOUSE

Office of the Press Secretary

For Immediate Release March 9, 1998

                             PRESS BRIEFING
                           BY CHRIS JENNINGS, 
          DEPUTY ASSISTANT TO THE PRESIDENT FOR HEALTH POLICY,
                             AND ELENA KAGAN, 
          DEPUTY ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY

                            The Briefing Room

1:49 P.M. EST

MR. TOIV: Good afternoon. As previously announced, we have -- the President earlier today, as you know, made a very strong push for two very important pieces of legislation, the Patient's Bill of Rights and comprehensive tobacco legislation. And here to talk just a little bit and to answer any questions you may have on those subjects are Chris Jennings, the Deputy Assistant to the President for Health Policy, and Elena Kagan, who is Deputy Assistant to the President for Domestic Policy.

Q What are the prospects on the Hill for getting these two bills through?

MR. JENNINGS: Just very, very brief, very, very brief, and then I'm going to have Elena talk, and then we'll do the Q's and A's.

Today, when the President went to the AMA, he was the first President in 15 years to go before the AMA. The last one was Ronald Reagan in 1983. And he pointed out that there are many issues that divide the AMA historically and the White House on a whole host of issues. But also there have been numbers that have -- unite us. And they include, of course, just most recently, the nomination and confirmation of Dr. Satcher to be Surgeon General. But the two issues that he specifically addressed today were the quality protections and the tobacco.

I'm going to talk about the quality protections for just a moment and advise you of the report that the President released today. It's this Patients' Protections in the States report that's now available to you. The most important part of this report is, as you may have heard, that some people on the Hill who oppose this legislation suggest that this quality protection is radical and out of the mainstream, et cetera. What this report does show is that -- and 44 states have passed already, and governors have signed legislation that passed -- that have enacted at least one of these provisions of the bill or rights, and many, many others have done many more.

And interestingly enough, 28 out of 32 governors have signed such legislation into law, too. And this is not a partisan thing, obviously, in so doing. I can say that because 90 percent of both Democrats and Republicans have signed this legislation into law. What this report does is it goes on a state-by-state basis through the Consumer Bill of Rights that the President has endorsed and it shows where the states all rank. Clearly there are some states that are coming closer to compliance and others who are not.

But the biggest point, of course, of all is that even if all states did so they would not have the jurisdiction over millions of Americans who are in self-insured plans and in federal health programs, which is why the President has called for federal legislation this year in the Congress -- called for bipartisan legislation to be passed this year. And we fully expect that we will get that done before the end of this Congress.

So with that, I'll conclude, bring Elena up, and then answer any questions you may have.

MS. KAGAN: The President also urged the AMA to continue pressing Congress to pass comprehensive tobacco legislation. As the President said in his radio address, as the President repeated today, there are about 70 working days the Congress has before they go out. And the President urged Congress to really apply themselves in order to be able to pass comprehensive tobacco legislation in those 70 days. This is a unique opportunity, a historic opportunity. And the challenge that the President made to Congress was you can take advantage of this opportunity and protect the health of our children or instead you can fail to do so.

As the President has said before, and as he talked about again to the AMA, passing comprehensive tobacco legislation now, according to our best estimates, will save over a million lives, or just about a million lives within the next five years. It will prevent about 3 million kids from starting to smoke, and as a result save about a million lives. So the President again made clear that Congress ought to step up to the plate and ought to pass comprehensive national tobacco legislation this year.

Q What are the prospects?

MS. KAGAN: We think the prospects are good. We think the prospects are strong. We have a lot of momentum that's been gaining in the Senate. There are some bipartisan bills that are being worked on. Senators Harkin and Chafee and perhaps a couple of others will probably introduce a bill soon. We also know that Senator McCain is working with both Republicans and Democrats on the Commerce Committee on a comprehensive tobacco bill. So we think that there has been a lot of progress made in these last few weeks. We think that there are people on both sides of the aisle who care about this, just as the President cares about this. And we think people will be embarrassed to go home without doing anything.

So when we put all that together, a commitment on the one hand and a little bit of embarrassment if nothing happens on the other, we think the prospects for getting comprehensive tobacco legislation are strong.

Q Senator Lott today said that any money from tobacco legislation should be used for anti-smoking programs and health measures, which seems to go a fair amount of the way toward what the President has called for, except Lott says it shouldn't be used for social programs. How do you view those statements? Are they helpful to your cause, or are you in disagreement with him?

MS. KAGAN: Well, there is an assumption in that statement, and the assumption is that Congress is going to pass comprehensive tobacco legislation and that there are going to be revenues that are generated as a result of that legislation. And we're very glad that Senator Lott and anybody else accepts that premise.

The question of how to spend those monies is, to us, a secondary one. Most -- our budget spends much if not most of those monies on health-related programs and on children-related programs. And we are very glad to engage Senator Lott or any other senator on the question of our priorities and their priorities and the question of how to spend these monies. But the most important thing is that we actually get the legislation that generates this revenue. And we're very glad to see Senator Lott and anybody else make statements that are based on the premise that we will.

Q The President today talked about his Medicare proposal. Are you -- can I ask a question about that? He talked about one part of it in which if a worker becomes eligible for Medicare under the rules now, and therefore drops out of private insurance, the worker's spouse would not necessarily be eligible if that spouse is younger. And the President wants to cover the spouse, as I understand it. Does that also include same-sex partners? It's not a frivolous question.

MR. JENNINGS: Under current Medicare statute that would not be applicable and therefore would not be included in our legislation. Beyond that I can't comment. I would say that what we are very excited about on the Medicare buy-in initiative, which for those of you who were around in the last Congress when we were debating CBO numbers versus OMB numbers, that the Congressional Budget Office absolutely confirmed the President's proposal, in fact, gave it some estimates that were showing that it would actually provide coverage to more people for less cost and would not undermine the Medicare Trust Fund in any way whatsoever. And it seems to us that to the extent that it meets that criteria and it helps real people and we have a real market failure in the individual market, particularly in those age groups, 55 to 65, it is absolutely inexcusable that we don't move ahead to address that.

And the President -- he mentioned these other two issues that we share common vision with the AMA -- this one they have not yet come to a conclusion on, but I'll tell you, this is something that should be at the highest priority level for congressional consideration, and it will certainly be one of ours this year. And the President referenced it in today's speech.

Q Chris, is the President proposing any specific changes in the Employee Retirement Income Security Act? And if so, what are they?

MR. JENNINGS: Well, the legislation assumes modifications to ERISA as it applies to a whole host of standards -- issues related to specialist coverage. In fact, you will recall, Robert, that on February 19th we got a report from the Labor Department that virtually every single federal -- every single consumer right that was recommended by the President's commission would not be covered under federal legislation for those self-insured plans, and therefore, clearly, by extension, we would have to modify ERISA to include those federal standards and those protections in order to ensure all Americans had those protections.

Q Can they sue for damages under the President's proposal?

MR. JENNINGS: The President has indicated that he believes that these bill of rights should be enforced. We have not made a final determination on exactly what the best enforcement mechanism is. As you know, there are bills on the Congress that do include remedies, state-based remedies. That certainly is one viable option. It is not the only viable option. And we look forward to working with the Congress to finalize a conclusion on that issue.

Q So you have no position on enforcement right now?

MR. JENNINGS: The position that we have is we believe that these provisions should be enforceable. The question really is how best to do it. One way is the one represented by many members of Congress, bipartisan support, endorsed by AMA and others, which include these state-based remedies. But that may not be the only remedy or the only option for enforcement, and we're working with the business community, the consumer community, and providers and others to develop and determine which is the best way to go.

Q Can you remind me, if you've got the figures, how much of this year's budget is dependent upon the tobacco settlement?

MS. KAGAN: I don't remember the percentage. Our budget projects that the tobacco legislation will generate about $65 billion over five years.

Q Senator Lott also suggested in his comments today that the White House hasn't been doing enough to push its priorities, including tobacco. Is there something that the White House has failed to do in your estimation? And what do you think about that comment?

MS. KAGAN: I think the White House has been working awfully hard impressing Congress on tobacco, and that Congress is beginning to move on tobacco exactly because we've been pressing so hard. Last fall the President stated his principles for tobacco legislation that really provided Congress with a road map for what that legislation ought to look like. This winter we gave a detailed budget which said exactly how much money we thought tobacco legislation ought to generate and how we would use that money.

And since then, we've been meeting with everybody who will meet with us. And we've been meeting with senators and with members of the House. We've been meeting with Republicans. We've been meeting with Democrats -- and talking to them about whatever part of this legislation they want to talk about. We've given clear guidance, and we are working this very hard. And we think that Congress is coming around or that there has been some momentum generated, particularly in the Senate, precisely because we're working it that hard. And we're going to continue to do so.

MR. JENNINGS: Any more questions.

(No response.)

MR. JENNINGS: Thank you very much.

END 2:00 P.M. EST