[Weekly Compilation of Presidential Documents Volume 34, Number 52 (Monday, December 28, 1998)]
[Pages 2509-2512]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Remarks at a Meeting With the President's Advisory Council on HIV/AIDS

December 18, 1998

[Sandra Thurman, Director of the Office of National AIDS Policy, made 
brief opening remarks and introduced the President.]

    The President. Thank you very much. I want to get right to the 
subject of listening to all of you, but I would like to say that, as all 
of you know, we had a very good couple of days when we finally made the 
budget last year--we've had a lot of good increases, a lot of things 
that I know you care so much about. But we've got a lot of work to do, 
especially in prevention and in the vaccine development I think we're 
going to--[inaudible]--pretty soon.
    I would prefer, I think, because we've met before and I try to stay 
familiar with our concerns--I think we've done a good job of getting the 
money into the programs this time, but there's a lot more we can do--
[inaudible]. However you organized this--[Laughter].

[At this point, Dr. Scott Hitt, Council Chair, introduced Rev. 
Altagracia Perez, cochair of the Council's Racial Ethnic Populations 
Subcommittee, who led the participants in a prayer. Dr. Hitt then 
commended the President for his commitment to AIDS research.]

    The President. Thank you.

[Dr. Hitt emphasized the need for better AIDS awareness efforts in 
ethnic communities, noting that many Americans do not know they are HIV-
positive. He stated that thousands of HIV-infected people cannot get 
early treatment as the Public Health Service recommends but instead must 
wait until they become disabled from the disease to become eligible. 
Council member Rabbi Joseph Edelheit noted the Council's duty was to 
ensure that help and treatment, such as needle-exchange programs and 
drug therapies, for those living with HIV/AIDS continued into the next 
century. He presented the President with a dreidel, the traditional 
Hanukkah toy, and said the Council hoped to revive the President's 
vision of a zero rate of transmission and equitable access to care for 
all persons battling HIV disease. Council member B. Thomas Henderson, a 
person living with HIV, noted the progress made under the President's 
leadership, but pointed out the need for reform in Medicaid coverage for 
HIV/AIDS to enable patients to receive early treatment prior to 
disability. Citing a Health Care Financing Administration evaluation 
which concluded that could not be done in a budget-neutral manner, Mr. 
Henderson suggested the administration should look for offset cost 
savings beyond Medicaid and consider a budget window longer than 5 
years, rather than relying solely on demonstration-program legislation 
introduced by Senators Jeffords and Kennedy. He concluded that drug cost 
issues should be addressed at the same time.]

    The President. Well, I'll see what I can do about that. You know, 
generally, this whole medical coverage problem is getting worse in 
America. It reminds me of that old joke that the Republicans used to 
tell on us--they told me if I voted for Barry Goldwater, we'd get 
involved in Vietnam too much. And I did, and sure enough, it happened. 
[Laughter] And they said when they attacked Hillary and me for our 
health care plan, they said that if people supported it, things would 
get worse. And sure enough, they did. [Laughter]
    We've had--these coverage problems have gotten quite profound, and 
as a consequence, with fewer and fewer people getting medical coverage 
at work, what you've got is more and more people trying to find a way to 
get into Medicare.
    One of the things, for example, that I want to look at as a result 
of this is something we're

[[Page 2510]]

doing with disabled people who get back into the workplace. I just 
started an initiative, not very long ago, to try and have people who 
have disabilities, which include some people with HIV and AIDS, and they 
get better--if you have disabilities and you go back to work, it used to 
be automatically you lose your Medicaid. And now more and more people 
are working in small businesses where they don't have employer-based 
health insurance, or they have small pools and they can't afford to take 
somebody with a preexisting condition.
    So we're trying to modify the rules so that when people are on 
disability, then they get off of it and they go back into the work 
force, they can keep their Medicaid for some period of time. And I want 
to go back and look and see exactly how we did that and what else we can 
do here.
    Tom, I want to make sure what you said. You believe that there are 
savings in non-Medicaid areas that would come from keeping people off--
help give people the drugs before they get sick in the first place.
    Mr. Henderson. As you know, the process right now is for States to 
seek 1115 waivers. We've been working closely with a number of States 
who have been working on those waivers for submission at the present 
time. They believe there are significant savings in SSI and SSDI, in 
other areas, that would result----
    The President. ----all would be counted.
    Mr. Henderson. Yes, sir. And current rules don't allow that.
    The President. I've got to go back and look at that. Part of it is 
the way the law disaggregates money into mandatory and nonmandatory 
spending. I'll look at it and see if we can do something about that. I 
know it's very important.

[At this point, Council member Bob Hattoy entered the meeting.]

    The President. I presume you still--hello, Bob.
    Mr. Hattoy. Hello, Mr. President. [Laughter] Sorry I'm late.
    The President. I'm glad you're here. [Laughter]
    Mr. Hattoy. I'm glad you're here. [Laughter]
    The President. [Inaudible]--notwithstanding what you said, you still 
think we ought to pass the Kennedy-Jeffords bill. They tell me it's a 
good bill.
    Mr. Henderson. Yes, sir. Absolutely. We just think that there are 
some things that can be done in the near term, though, within the 
administration, that do not require legislation, that they would move 
this problem forward.
    The President. I'll do some work on it--what you said.

[H. Alexander Robinson, cochair of the Council's Prevention 
Subcommittee, said prevention of new infections remains a problem. He 
proposed Federal funding for needle-exchange programs and a bold 
national media campaign by the White House Office of National AIDS 
Policy to promote voluntary HIV testing, to be modeled on the national 
youth antidrug media campaign.]

    The President. It sounds like a good idea. I think Sandy is going to 
come up with a proposal, I think, about what we should do, but I think 
it's a good idea.
    Ms. Thurman. We'll work with you and get one done.
    The President. And it offers the promise of sort of getting by the 
divisive arguments of the past and actually doing something. I like it.
    Participant. Proactive.

[Council member Helen Miramontes stressed the need for continuing 
research both in vaccines and therapeutics. Praising establishment of a 
10-year goal for finding a vaccine, she pointed out the need to appoint 
a director for the vaccine center at the National Institutes of Health 
as soon as possible; to follow up on the preliminary vaccine meeting; to 
place a council-recommended vaccine effort coordinator within the Office 
of National AIDS Policy; and to develop and implement a comprehensive 
plan.]

    The President. Well, let me make a couple comments. First of all, I 
think the vaccine director is about to be appointed. I've been as 
patient about that as you have--[inaudible].

[[Page 2511]]

    Secondly, I do think Dr. Neal Nathanson, the new Director of the 
Office of AIDS Research has been doing quite a good job. We got about a 
33-percent increase in funds for vaccine research in the last budget, so 
that's good. And we're going to try to--I just had a brief meeting, 
before I came in here, with our folks, talking about how we can expand 
Sandy's office over here and introduce this kind of work and kind of 
ride her on this thing. I think that's important. It does make a 
difference just to have a sort of sustained White House involvement on 
any kind of project to keep cutting through the resistance.

[Council member Regina Aragon addressed the need for meaningful and 
substantial increases in HIV funding in the fiscal year 2000 budget. She 
thanked the President for his efforts in securing $156 million in 
funding for a Congressional Black Caucus initiative to address the AIDS 
crisis in the African-American and Latino communities but noted that 
conditions require a sustained and expanded Federal response. Ms. Aragon 
also underscored the importance of funding for a national testing 
awareness media campaign. Michael T. Isbell, cochair of the Council's 
Prevention Subcommittee, noted that more than 90 percent of HIV 
infections occur in the developing world. He commended the President for 
a $10 million program addressing the needs of AIDS-affected women and 
orphans and suggested making that funding a permanent part of the U.S. 
Agency for International Development. Saying that U.S. funding for 
global AIDS activities had declined in real dollars since 1993, he urged 
more funding in the upcoming budget and improved coordination of Federal 
international AIDS efforts.]

    The President. Well, in general, let me say I think the budget 
should reflect better attention both to prevention at home and to the 
communities of color. And I've been trying to get more money for the 
USAID mission, and we'll put some more money in there. I think I'd like 
to make two points.
    One is that this budget year will be more difficult than the last 
one because we got such big increases in everything last time. And 
because of the global economy kind of slowing down, we don't expect the 
same amount of revenues to come in this time, and we have to fund all 
the big increases we got last time again. But we'll do the best we can.
    The second thing I would like to say is I think that it would be 
very helpful to have all of you using your--whatever influence you have 
with Members of Congress in both parties to support more global efforts, 
because eventually all this is going to be a menace to the United 
States. So it's not only a moral imperative, it's also very practical 
over the long run.
    One of the things that has kind of bothered me is that in the 
aftermath of the cold war we were able for several years to reduce our 
defense budget, and that was a good thing and everyone--and even the 
Pentagon wanted to do it. There was just like about 300,000--the number 
of civilian employees--and they plan for further reductions there. But 
during that time, we actually needed to make a larger commitment on the 
diplomatic front or in the nondefense security areas, if you will. And 
with the exception of the special efforts we made in the former Soviet 
Union to dismantle and destroy nuclear weapons, basically there's been a 
wholesale effort to cut back on our diplomatic budget even though, 
contrary to popular wisdom, the United States spends a smaller 
percentage of our income on international affairs than any other major 
country.
    And one of the things that I have seen--almost no one knows this, 
but it's true--one of the things I have--now, to be fair, we also spend 
more on defense, and a lot of our defense goes to protect other 
countries, as you see in the last couple of days. But still, for the 
numbers--are so much more modest, not only for--if you just look at the 
USAID program, the health programs, the empowerment of women and 
children, especially young girls, initiative, the small scale 
microeconomic development--all that stuff that doesn't cost much money 
and it has a huge impact--and especially a lot of the things we can do 
in public health.
    And, interestingly enough, a lot of the preventive activities that 
we would engage in with regard to AIDS, for example, would go quite well 
with other things we need to be doing out there with these large 
populations

[[Page 2512]]

anyway in a lot of countries that have severe public health problems.
    So we've been sitting here meeting in our--I've been having each of 
the last 3 or 4 days rather long, detailed budget sessions, trying to 
figure out how to get more blood out of that turnip. And one of the 
things that I'm trying to do is to figure out how to make the case to 
the Congress in an effective way that the United States has enormous 
interests, as well as obligations, in making these kinds of investments 
beyond our borders.
    And I think anything you can do to help that, I would appreciate it. 
I mean, there is this sort of general awareness in Congress that the 
world is becoming more interdependent. There's a much more sophisticated 
understanding of the economics, for example. But it's not just 
economics. It's the environment; it's the public health; it's all these 
other things where we are becoming more and more caught up with each 
other.
    Our major military mission in the last 6 months, before the 
operation in Iraq, has been to send several thousand of our uniformed 
personnel to Central America to help them rebuild after Hurricane Mitch. 
It's not only the right thing to do from a humanitarian point of view, 
it is in our national interest. Because if those countries don't 
rebuild, they will become highly vulnerable to all the drug traffickers. 
And if they don't rebuild, then all their people will have to come here 
and, if they can't get here legally they will try to come illegal 
immigrants. So there's all these things that we need to begin to see our 
relationships beyond our borders, as more of an extension of our 
relationships with one another, rather than as something totally 
different and apart from our relations with one another.
    And anyway, I don't mean to give you a speech on that; I know you 
believe that. But the point I want to make is most people who run for 
Congress never have to think about these things unless they have a large 
immigrant population within their district from a particular place. So 
it doesn't--this kind of discussion we're having, because you understand 
the HIV/AIDS issue--I'm preaching to the choir here. But anything you 
can do to sort of just sit down and walk through this with congressional 
delegations or their chiefs of staff or whoever the appropriate people 
are from around the country, I would really appreciate, because I think 
there is a lot of support. For example, you can always get good support 
in Congress, bipartisan, for a big increase in the Ryan White Act. And 
now we've finally got pretty good support in Congress, this whopping 
increase we had to help people purchase the drugs, the medicines. But it 
drops off markedly when you try to talk about the connection between 
what we're doing here at home and beyond our borders. And I really think 
you could help, because this is one example of a more general challenge 
the country will have to face--more every year for the next 20 years--
maybe forever, but certainly for the next 20 years.
    Dr. Hitt. Mr. President, we really have made--probably hundreds of 
recommendations in the past few years, I mean--[laughter]. We've tried 
our best to narrow down----
    The President. This is the most energetic--[laughter].
    Dr. Hitt. But we have narrowed down a few specific initiatives we 
brought to your attention today. And the reason is clear, that we've 
talked to many administration officials and this is where we feel that 
there's a logjam that you can really help and get involved in and take 
it to heart.
    The President. I will.
    Dr. Hitt. And thank you again for meeting with us.
    The President. Thank you for the dreidel, the book, the letters. 
[Inaudible] Thank you very much.

Note: The meeting began at 5:45 p.m. in the Cabinet Room at the White 
House. This item was not received in time for publication in the 
appropriate issue.