[Public Papers of the Presidents of the United States: William J. Clinton (1997, Book I)]
[February 20, 1997]
[Pages 179-182]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks on Medicaid Patient Protection and an Exchange With Reporters
February 20, 1997

    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 o'clock 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 Fried 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.

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    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 HMO's 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 HMO's and other health 
plans should know that their 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 the right to 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 HMO's 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.
    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; is it 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 these 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.

Mexico

    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

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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 you know, 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?
    The President. Excuse me?
    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 
counterweight. 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.

China and Cabinet Nominees

    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 2 years now. 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 in 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

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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.

Note: The President spoke at 11:05 a.m. in the Oval Office at the White 
House. In his remarks, he referred to Bruce Vladeck, Administrator, 
Health Care Financing Administration; Bruce Fried, Director, HCFA Office 
of Managed Care; Gen. Jesus Gutierrez Rebollo, Director of Mexico's 
National Institute to Combat Drugs, dismissed for allegedly protecting a 
Mexican drug trafficker; President Ernesto Zedillo of Mexico; Deng 
Xiaoping, former President of China; and Anthony Lake, nominee for 
Director of Central Intelligence.