[Weekly Compilation of Presidential Documents Volume 29, Number 5 (Monday, February 8, 1993)]
[Pages 117-119]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Remarks Following a Meeting With the Nation's Governors

 February 1, 1993

    The President. Well, I want to say good morning to the members of 
the press who are here from Washington and many of you from around the 
Nation.
    I'd like to read a statement and then call on the Governors, Romer 
and Campbell, to make a statement about the meeting we had here today 
and the actions which I will take today as a result of this meeting and 
the work that I have been doing over the last couple of months.
    The day before my Inauguration, on one of the last days people 
called me Governor, I had lunch with many of the Governors here and many 
others with whom I have served over the past 14 years. I pledged to them 
a partnership between the country's Governors and this administration, 
rooted in our common experience on the front lines of people's lives.
    I've told my friends, my colleagues, that the one thing I hoped that 
I could actually demand from them was a commitment to keep me rooted in 
that common experience and the real problems of real people. The White 
House, after all, only works when it is the people's house.
    Today we have continued our partnership in earnest. We agreed to 
challenge together the one obstacle that could keep us from success in 
virtually every arena of national endeavor: the twin monsters of 
spiraling health care costs and the agony of having no access to health 
care, no health care coverage, or living in fear of losing it.
    Left unaddressed, the health care crisis has had devastating impacts 
on families, businesses, the fiscal conditions of State and local 
government, and the economic performance of the United States. For 12 
years our national Government has ignored the problem, partisan gridlock 
has prevented action, and Americans are paying the price. The amount we 
spend on health care has more than tripled. Now we spend far more than 
any other nation on Earth, about 30 percent more of our income, and we 
get less for it.
    We send American companies out into the world with this 30 percent 
handicap simply because of high health care costs. The average American 
car alone includes over $1,000 in health care costs, twice as much as 
its Japanese competitor. You know as well as I do that the real people 
of this country are paying the price: working families who live in fear 
of losing their insurance; small businesses who have to choose between 
dropping coverage or going broke; State and local governments who have 
to balance their books every year and are now choosing between cutting 
education, raising taxes, or cutting other needed investments just to 
pay more for the same health care bills.
    If every person striving to overcome this challenge will bring to 
that work the same depth of drive and determination that our Nation's 
Governors have brought here to the White House today with their policy 
position, the American people will have the commitment it takes to solve 
this problem.
    This meeting was a model of everything I want my relationship with 
our Governors to be. It wasn't scripted or staged. It was simply an 
honest discussion where real work was done, real opinions were argued 
and a room filled with women and men who left their partisan banners 
outside the door. And in that spirit and what I hope is the first of a 
series of announcements we will make together, I want to announce that I 
am taking the following steps to help them meet the health care needs of 
their people in their States.
    For years the Nation's Governors have been arguing that the process 
through which waivers from the Medicaid mandates im- 

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posed on them by the Federal Government is Byzantine and 
counterproductive. They are right. I have today directed the Department 
of Health and Human Services and its health care financing agency to 
take immediately a series of actions designed to streamline the Medicaid 
waiver process to enable the States of our country to serve more people 
at lower costs. These include a requirement that from now on the health 
care financing agency and its regional centers will have only one 
opportunity to ask for additional information and clarifications on 
States' waiver requests. I also want the health care financing agency to 
examine the development of a list of standard initiatives for automatic 
approval for State action.
    In consultation with the National Governors' Association, I want a 
rapid review of the entire waiver request process that produces a list 
of additional streamlining recommendations within 60 days. And I am 
directing the health care financing agency to reopen negotiations with 
the National Governors' Association to issue new regulations related to 
how they can use provider taxes and disproportionate share reimbursement 
to meet the needs of the people in their State.
    Finally, I am directing the Department of Health and Human Services 
to conduct a similar review of the non-Medicaid waiver submissions not 
addressed in the matters I have just discussed.
    I'm also happy to announce that Hillary and the leadership of the 
National Governors' Association have agreed on a formal process for the 
Governors to have input into the Health Care Task Force. Their input, 
their advice, their perspective is essential to our success. When all 
this is said and done, the health care problems of this country can only 
be met if we have a good partnership.
    And for those of you in the press and the general public who may not 
understand all the language that I have used about Medicaid and waivers, 
if I could put it in simple terms, it amounts to this: The Federal 
Government requires the States to provide a certain number of health 
services in a certain way to people who are poor enough to qualify for 
Medicaid. The States very often believe that they can provide more 
services at lower cost if we don't impose our rules and regulations on 
them.
    For years and years and years, Governors have been screaming for 
relief from the cumbersome process by which the Federal Government has 
micromanaged the health care system affecting poor Americans. We are 
going to try to give them that relief so that for lower costs we can do 
more good for more people. This will be one big step on a long road to 
giving this country the kind of health care system it needs.
    Governor Romer.
    Governor Romer. We have had a very fruitful over 2 hours of 
discussion. And I speak for both Republican and Democratic Governors and 
the two Independents when I say that this issue of flexibility on the 
waiver process has been critical to us, and the prompt response of this 
administration to give us more flexibility, give us more certainty, give 
us quicker deadlines will simply help us to do our job better.
    Now, in addition to the short-term measures, we've had some 
extensive discussion about what kind of long-term health care reform we 
need to do together. There is an acknowledgement it has to be a 
partnership between the Federal and the State government. There's an 
acknowledgement that we have made a good start; the Governors' 
Association will have on its agenda in the next few hours some measures 
relating to cooperation with this administration on managed care. And if 
you have further questions about that, we'll be available out on the 
lawn very shortly.
    And I want to say in closing that we've had a very strong bipartisan 
approach in the Governors' Association. And I want to compliment 
Governor Campbell and his colleagues for working with the Democrats in 
the Governors' Association and this administration. We know that we need 
to solve this problem on a bipartisan basis, and I think we made a very 
good start here this morning.
    Thank you.
    Governor Campbell. Mr. President, we appreciate the opportunity to 
work with you in a bipartisan sense to find an answer to some of the 
problems that are really driving the States' costs to the point that we 
cannot fund the programs that we need to fund. The

[[Page 119]]

cost shifting away from such important items as education to fund rising 
medical costs are, of course, driving all of our States.

    We all realize that it is a difficult program and, quite frankly, 
that it probably cannot be solved in short order. But we're willing to 
roll up our sleeves and go to work with you and try to find those 
answers. We recognize the need to get the small employers into a 
position that they have access to groups and lower cost insurance for 
their employees. We recognize the need to go into preventive care. We 
know that there is a problem with the preventive care aspect in that the 
liability costs and the cost of doing this in the private sector are, in 
fact, prohibitive.

    I would think that after our discussion, the opportunity may exist 
for us to look at the immunization side of preventive care from a joint 
national framework in order to meet some of these needs, much as we 
would do if we did a crash program for any country that was in need that 
we were aiding, doing it for ourselves.

    I believe that working together we can, in fact, find some answers. 
We know that there has to be competition. We believe in managed 
competition. We also believe that there has to be a structure that lets 
people have access to primary care physicians instead of just the 
emergency rooms for their care because of the cost factor, as well as 
the fact that it's not a preventive type of program.

    So we, as members of the National Governors' Association, look 
forward to continuing this work with you and continuing to work with 
Hillary and her task force, because we think that working together that 
we will find answers.

    And in closing, let me just add my thanks to your willingness to 
expedite the waiver process and to deal with some of the problems that 
have been so vexing for us as Governors as we've tried to deal with this 
overall problem. We appreciate it.

    The President. That's our statement. I know a lot of you here want 
to take pictures of your Governors, so have at it.
    Governor King, of all of the people of America, they know you from 
behind as well as from the front, but turn around. I think you ought to 
turn around. How about giving them a profile, at least, that sort of 
tough western profile? [Laughter]
    Thank you all very much.

Note: The President spoke at 11:23 a.m. in the East Room at the White 
House.