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Date: Tuesday, Dec. 31, 1996 FACT SHEET Contact: HHS Press Office, (202) 690-6343
Today, those commitments are paying off. Childhood immunization rates are at their highest levels ever in this country, and infant mortality is at an all-time low. There are 2 million fewer people on welfare, and teen pregnancy rates are going down. We're making work pay with more child care, better child support enforcement, an expanded Medicaid program, and a reformed welfare system.
We launched an historic children's tobacco initiative to take power back from the cigarette companies and put it in the hands of parents. We demanded quality from every Head Start program. And we dramatically reduced drug approval time at the FDA, allowing new advances in AIDS and other pharmaceuticals to reach Americans faster, while preserving high standards for safety and effectiveness.
Under our "zero tolerance" policy for fraud and abuse, our Operation Restore Trust program is saving $10 in health care costs for every anti-fraud dollar we spend. And we're protecting Medicare for seniors and the disabled, giving beneficiaries enhanced benefits and greater choice in their medical care.
Over the next four years, we must complete the job in many of these areas - and prepare to meet the goals of the 21st century. We must reduce the ranks of the uninsured, especially among our children. We must ensure that the quality of health care in America remains among the best in the world. We must continue to aim at independence for all Americans, while providing a safety net when help is needed. We must aggressively address the problem of teen drug and alcohol abuse. We must extend our crusade against waste, fraud and abuse. And we must assure the solvency of the Medicare program in both the near- and long-term, for all Americans young and old.
These are tough challenges. But in an America where the doors of opportunity are wide open and the keys of responsibility are in every person's hands, we can achieve them.
Record Childhood Immunization Levels. In April 1996, HHS announced that the national infant immunization rate is at an all-time high and vaccine-preventable childhood diseases are at historic all-time lows. According to CDC's most recent National Immunization Survey, which surveys parents of preschoolers nationwide, 75 percent of two-year-olds in the United States received their full series of shots as recommended. On December 9, 1996, Secretary Shalala launched a new nationwide public service campaign to encourage parents to make sure their children are adequately immunized.
Revised Head Start Performance Standards. In November 1996, HHS published revised Head Start Program Performance Standards, developed with the consultation of thousands in the Head Start field, that improve on the program's existing quality standards. These revised, more user-friendly standards remove rigid and prescriptive requirements, integrate infants and toddlers into the Head Start program, promote collaboration with other community programs, and draw on medical expertise. In the spirit of the Administration's reinvention goals, the revised Head Start Program Performance Standards were developed based on communication with Head Start and early childhood program practitioners. This new version focuses on quality services for children, including infants and toddlers, and their families. It was published as a final rule in the Federal Register on November 5, l996.
New Early Head Start Grants. On September 10, 1996, Secretary Shalala announced new "Early Head Start" grants for programs that will provide comprehensive support and services to low-income families with children under three and pregnant women. For FY 1996, HHS awarded 74 new Early Head Start grants. At a funding level of $40 million, this expansion will serve nearly 6,000 more children and their families. Combined with last year's grants, Early Head Start now totals 142 programs across the country. The programs will provide a range and variety of services to children and their families. Using the successful Head Start model, Early Head Start will offer a basic early education, nutrition, health and family development approach. Yet to meet the unique requirements of very young children, the programs will test new services as well, including special health needs for newborns, a three-generational model with grandparents, parents and children, and strong parent-child interaction models. Also, some programs will target families with particular needs, such as teen parents and families with histories of substance abuse.
Preventing Birth Defects. U.S. food manufacturers will add the nutrient folic acid to most enriched breads, flours, corn meals, pastas, rice and other grain products to reduce the risk of neural tube birth defects in newborns, as a result of action taken in February 1996 by the Department of Health and Human Services and the Food and Drug Administration. Folic acid, or folate, reduces the risk of neural tube birth defects such as spina bifida when consumed in adequate amounts by women before and during early pregnancy.
President Clinton's Initiative to Prevent Youth Tobacco Use. On August 23, 1996, President Clinton announced the nation's first comprehensive program to prevent children and adolescents from smoking cigarettes or using smokeless tobacco and beginning a lifetime of nicotine addiction. The President's initiative to protect children is based on the final FDA rule, published in August 1996, that will make it harder for young people to buy cigarettes and smokeless tobacco and will reduce the appeal of tobacco products to children under 18. The rule is based on the Agency's finding that cigarettes and smokeless tobacco products are delivery devices for nicotine, an addictive drug. In addition to the rule, the FDA will propose to require tobacco companies to educate children and adolescents about the health risks of tobacco use as part of the President's initiative. This national mass media campaign would be monitored for its effectiveness. FDA intends to begin consultations about this campaign with the nation's six tobacco companies with a significant share of sales to children.
Preventing Teen Pregnancy. The Administration's strategy to prevent teen pregnancy is based on five principles that research and experience tell us are key to promising community efforts: parental and adult involvement; strong messages of abstinence and personal responsibility; clear strategies for young people's futures; involvement by all facets of the community; and a sustained commitment to young people. Beginning in FY 1996, as part of President Clinton's teen pregnancy prevention strategy, HHS funded 17 grants totaling $5 million to innovative and comprehensive demonstration programs to prevent early teen sexual activity, reduce teen pregnancies, and develop and implement innovative comprehensive programs for pregnant and parenting teens. HHS also implemented the CDC Teen Pregnancy Prevention Program with grants to 13 community-wide coalitions in communities with high rates of teen pregnancy. In addition, at President Clinton's insistence, the new welfare law includes provisions requiring teen mothers to live at home, stay in school, and turn their lives around. The Department will build on our work in this area in launching a national strategy to reduce out-of-wedlock teen pregnancy and assure that at least 25 percent of communities have teen pregnancy programs in place.
Reality Check Anti-Marijuana Campaign. On June 24, 1996, Secretary Shalala launched Reality Check, a national public education campaign designed to counter recent increases in marijuana use by youth. The campaign is targeted in particular at improving information and communications about marijuana. Keeping Youth Drug Free: A Guide for Parents, Grandparents, Elders, Mentors and other Caregivers, the key ingredient of the Reality Check campaign, endorsed by the National PTA, is designed to help parents talk with their children about drug issues. The PTA will work with HHS toward the goal of distributing the guide to some 14 million parents. The campaign also includes: a Reality Check Community Kit, with ready to use local campaign materials; "Tips for Teens About Marijuana" and other materials targeted for youth; poster displays in hundreds of malls and grocery stores throughout the country, which will carry the slogan, "Marijuana is a drug. Help your kids understand;" and a Reality Check marijuana web site on the National Clearinghouse for Alcohol and Drug Information (NCADI) homepage (www.health.org/reality).
Girl Power! Launched in November 1996, "Girl Power!" is a multi-phase, national public education campaign sponsored by the Department of Health and Human Services (HHS) to help encourage and empower 9- to 14-year-old girls to make the most of their lives. Studies show that girls tend to lose self confidence and self worth during this pivotal age, becoming less physically active, performing less well in school, and neglecting their own interests and aspirations. It's during these years that girls become more vulnerable to negative outside influences and to mixed messages about risky behaviors. Girl Power! is designed to combine strong "no-use" messages about tobacco, alcohol, and illicit drugs with an emphasis on providing opportunities for girls to build skills and self-confidence in academics, arts, sports, and other endeavors.
Declining Welfare Rolls. Due in part to both the Clinton Administration's early emphasis on state welfare reform demonstrations and its policies to strengthen the economy, welfare rolls are down by 2.1 million since President Clinton took office in January 1993. The number of AFDC recipients has fallen from 14.1 million in January 1993 to 12 million in September 1996, a decline of 15 percent. While working toward the passage of comprehensive welfare reform legislation, the Clinton Administration approved 79 welfare-to-work programs in 43 states -- more than all previous administrations combined.
Record Child Support Enforcement. Since taking office, the Clinton Administration's partnership with states has yielded unprecedented financial support for children. In 1996, the federal-state child support enforcement system collected a record $11.8 billion from non-custodial parents, up from $8 billion in FY 1992. The Federal government also collected a record of over $1 billion in delinquent child support by intercepting income tax refunds of non-paying parents for tax year 1995. Preliminary data for paternity establishment show an estimated 800,000 in FY 1996, up from 515,857 in FY 1992. Under President Clinton's comprehensive child support enforcement plan -- included at the Administration's urging in the new welfare law -- child support collections could increase by $24 billion over the next 10 years. In addition, while working toward comprehensive improvement of child support enforcement, President Clinton used his executive authority to increase child support collections. In 1996, President Clinton directed the Treasury Department to activate a centralized, streamlined Federal system to offset child support debts against most Federal payments; ordered Federal agencies to take necessary steps to deny loans, loan guarantees, or loan insurance to any individual who is delinquent on child support debt; and issued an executive order to make the federal government a model employer in the area of child support enforcement.
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996. On August 22, President Clinton signed into law "The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193)," a comprehensive bipartisan welfare reform plan that will dramatically change the nation's welfare system into one that requires work in exchange for time-limited assistance. The law contains strong work requirements, a performance bonus to reward states for moving welfare recipients into jobs, state maintenance of effort requirements, comprehensive child support enforcement, and supports for families moving from welfare to work -- including increased funding for child care and guaranteed medical coverage.
National Health Statistics. On October 4, 1996, HHS Secretary Donna E. Shalala released annual preliminary vital statistics findings for 1995, showing broad gains in national health indicators. The report, "Births and Deaths for 1995," prepared by the National Center for Health Statistics, part of HHS' Centers for Disease Control and Prevention, contains the latest preliminary U.S. natality and mortality statistics. According to the report, the U.S. last year achieved: an historic low infant mortality rate; continued increase in the number of women obtaining early pre-natal care; the first decline in the birth rate for unmarried women in almost 20 years; continued decline in the teen birth rate; a dramatic decline in homicide rates; a leveling in the HIV/AIDS death rate, for the first time since the epidemic took hold; and continued increase in life expectancy.
Cancer Death Rate Declined for the First Time Ever in the 1990s. The National Cancer Institute (NCI) announced on November 14, 1996 that the cancer death rate in the United States fell by nearly 3 percent between 1991 and 1995, the first sustained decline since national record-keeping was instituted in the 1930s. The rates reported by NCI are based on mortality data collected by the National Center for Health Statistics of the Centers for Disease Control and Prevention.
Reducing SIDS Mortality. On October 9, 1996, Secretary Shalala announced that deaths due to Sudden Infant Death Syndrome (SIDS) fell 30 percent between 1992 and 1995. This includes a 12 percent drop in 1994 and an 18.5 percent drop in 1995, the largest annual declines ever observed in the U.S. and the only large declines observed in two consecutive years. Secretary Shalala credited the public-private 'Back to Sleep' campaign, which recommends that babies be placed on their backs to sleep to reduce the risk of SIDS, with bringing about the improvement in SIDS mortality. This recommendation, made by the American Academy of Pediatrics in 1992, is the backbone of the HHS campaign, initiated in 1994 by the National Institute of Child Health and Human Development, one of the National Institutes of Health.
The Health Insurance Portability and Accountability Act of 1996. On August 21, 1996, President Clinton signed into law the Health Insurance Portability and Accountability Act of 1996, which includes important new protections for an estimated 25 million Americans (approximately 1 in 10) who move from one job to another, who are self-employed, or who have pre-existing medical conditions. The legislation, which was jointly sponsored by Sen. Edward Kennedy (D-Mass.) and Sen. Nancy Kassebaum (R-Kan.), was approved virtually unanimously by the House and Senate. It is designed to improve the availability of health insurance to working families and their children.
Growth in Managed Care Enrollment. As of November 1, 1996, approximately 4.7 million Medicare beneficiaries were enrolled in managed care plans, accounting for 12 percent of the total Medicare population. That represents an 87 percent increase in managed care enrollment since 1993. In 1995, an average 80,000 Medicare beneficiaries voluntarily enrolled in risk-bearing HMOs each month. Enrollment in Medicaid managed care plans has also increased significantly. Since Jan. 1, 1993, enrollment in Medicaid managed care plans has increased by more than 140 percent, including a 51 percent increase in 1995 alone. As of June 30, 1995, 11.6 million Medicaid beneficiaries were enrolled in managed care plans, representing 32 percent of total beneficiaries.
State Medicaid Demonstrations. Since January 1993, HHS has approved 15 comprehensive health care reform demonstration projects, and the framework of one additional demonstration. In addition, 19 states have received Medicaid waivers since January 1993, as part of larger welfare reform projects. These complementary Medicaid waivers enable states to continue providing essential health care services while encouraging independence from welfare. Finally, 25 sub-state Medicaid demonstration projects have been approved, affecting smaller components of state Medicaid programs.
Increasing Access to New Therapies. In FY 1996, the FDA approved a record 46 new drugs (new molecular entities). Among the therapies approved were six for AIDS and nine for cancer. New agents were also approved for difficult to treat conditions such as Lou Gehrig's disease and Alzheimer's disease. FDA also approved six new vaccines. In addition, on March 29, 1996, President Clinton announced a major initiative to make promising new cancer therapies available sooner to American cancer patients. Also, on September 26, 1996, FDA announced final rules to make it easier for promising experimental drugs and devices to be studied in persons who are in life-threatening situations and unable to give consent for their use.
Office of Cancer Survivorship. On October 27, 1996, President Clinton unveiled the new Office of Cancer Survivorship at the National Cancer Institute. Recent success of cancer prevention, early detection, and treatment efforts has created a new need: research into the physical, psychological, and economic well-being of the growing number of cancer survivors. The Office of Cancer Survivorship will support research covering the range of issues facing survivors of cancer, including: long term medical and psychological effects; factors that predispose survivors to second malignancies; reproductive problems following cancer treatment; and their unique insurance and employment issues.
Surgeon General's Report on Physical Fitness. Regular physical activity offers substantial benefits in health and well-being for the vast majority of Americans who are not physically active, according to the first-ever Surgeon General's Report on Physical Activity and Health released on July 11, 1996. The report, which was commissioned by Secretary Shalala, also concludes that regular moderate physical activity can reduce the risk of developing or dying from heart disease, diabetes, colon cancer, and high blood pressure.
Operation Restore Trust. On May 13, 1996, Secretary Shalala marked the first-year anniversary of HHS' anti-fraud initiative, Operation Restore Trust, saying new approaches in the pilot program have already produced $42.3 million in recoveries. This constitutes a return of $10 in recoveries for every $1 spent on the project. The pilot project is operating in five states, and the Clinton Administration has proposed expanding it to all 50 states in the coming fiscal year. With first-year targeted demonstration project funds of $4.09 million, Operation Restore Trust has produced $42.3 million in restitutions, fines, settlements and recovery of overpayments. This includes $24.5 million returning to the Medicare Trust Fund from criminal restitutions, fines and recoveries; $14.1 million returning to the Trust Fund as a result of civil judgments, settlements and penalties; and $3.7 million returned to the Treasury as a result of services inappropriately billed or medically unnecessary services rendered.
Centers of Excellence in Women's Health. On October 1, 1996, HHS announced the establishment of six National Centers of Excellence in Women's Health to serve as national models for improving the health care of American women. The six centers, located at academic institutions in different areas of the country, will serve as demonstrations and models which can be evaluated and duplicated throughout the nation. The centers will integrate health care services, research programs, public education, and health care professional training, and will forge links with health care services in the community.
National Action Plan on Breast Cancer Web Site. On Oct. 27, 1996, President Clinton launched a new Internet Web site for the National Action Plan on Breast Cancer. The Web site, developed by a public/private partnership and coordinated by HHS' Office on Women's Health, is designed to serve as a gateway to information on breast cancer research, treatment and prevention. The Web site provides answers on frequently asked questions about breast cancer, as well as information on the Action Plan, breast cancer clinical trials and research, breast cancer organizations and advocacy groups, educational conferences, publications, and government and private resources. The web site address is www.napbc.org.
Breast Cancer Gene Research. This discovery may lead to new treatment and prevention strategies. On October 27, 1996, President Clinton announced $30 million in new funding for research into the genetic basis of breast cancer.
Promoting Breast and Cervical Cancer Early Detection. The CDC's National Breast and Cervical Cancer Early Detection Program builds an infrastructure in states and communities to reduce deaths from breast and cervical cancers among all women through public and provider education, quality assurance, evaluation, and partnerships. The program also provides affordable screening services for underserved women, particularly low income, elderly, and minority women. On October 1, 1996, Secretary Shalala announced the expansion of the program to all 50 states, with over 1 million women having already received these life-saving services.
Imaging Technology. HHS is working with other federal agencies, including NASA, the Defense Department and the CIA, as well as private companies, to adapt high-tech imaging technology to improve the early detection of cancer in women. In September 1996, HHS, in collaboration with the CIA, awarded $1.98 million to the University of Pennsylvania to conduct a series of clinical trials of imaging technology from the intelligence community -- originally intended for missile guidance and target recognition -- to improve the early detection of breast cancer.
Preventing Violence Against Women. In February 1996, President Clinton announced the opening of a 24-hour, toll-free hot-line to provide crisis assistance and local shelter referrals to victims of domestic violence throughout the country. Since its opening, the hotline has received over 72,000 calls. Phone number: 1-800-799-SAFE. In October 1996, the Advisory Council on Violence Against Women distributed a Community Checklist, which includes steps that every facet of a community can take to prevent domestic violence. The Council, created in July 1995, is co-chaired by the Attorney General and HHS Secretary and consists of 47 experts -- representatives from law enforcement, media, business, health and social services, victim advocacy and survivors -- helping to steer new efforts to prevent violence against women.
FDA approves new advances. In 1996, the FDA approved a new class of AIDS drugs called protease inhibitors. Indinavir, the third of these drugs to be approved by the FDA, received full approval for people with advanced HIV disease in 42 days. On May 14, 1996, the FDA approved the first HIV test system that includes collection of blood samples at home. The new testing system is comprised of three integrated components: an over-the-counter home blood collection kit, HIV-1 antibody testing at a certified lab, and a test result center that provides test results, counseling and referral anonymously.
Death Rates improve. In October 1996, HHS reported that in 1995, for the first time since the epidemic took hold, the HIV/AIDS death rate did not increase from the previous year and in November, the Centers for Disease Control and Prevention reported a sharp decline in the number of infants born HIV-infected. The number of reported cases of perinatally acquired (mother-to-infant) AIDS declined by 27 percent between 1992 and 1995, according to information released by the Centers for Disease Control and Prevention (CDC). Increased use of perinatal zidovudine (AZT) therapy by HIV-infected pregnant women and their newborns is the most likely factor leading to this reduction, CDC said.
Increased Funding for the Ryan White CARE Act. Funding for the Act has increased by 158 percent since President Clinton took office. On May 20, 1996, President Clinton signed a five-year reauthorization of this program, guaranteeing assistance until the year 2001. Funding for AIDS drug assistance has increased by 221 percent.
HHS Funds Innovative Aids Programs Under the Ryan White CARE Act. On September 26, 1996, Secretary Shalala announced the award of $7.1 million in federal funds to 19 innovative community-based AIDS service programs. The programs are designed to improve the delivery of care to HIV-positive and/or at-risk individuals, including homeless persons, those with mental illness or substance abuse problems, women and children, adolescents, Native Americans, and former prisoners. Two grants were awarded through a new collaboration between HHS and the Department of Housing and Urban Development (HUD). On December 13, 1996, Secretary Shalala announced the award of $227.7 million to 20 states, the District of Columbia, and Puerto Rico to provide care to Americans living with AIDS and HIV. On December 13, Secretary Shalala also announced $3.35 million in 2-year continuation awards for nine projects in six states to evaluate and disseminate health care and support services delivery models for HIV-infected and at-risk adolescents.
Microbicide Initiative. At the Eleventh International Conference on AIDS this year, Secretary Shalala announced a new effort to develop safe and effective topical microbicides to help women protect themselves against HIV infection. The initiative includes a $100 million commitment to research and development.