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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

Kristen Silverberg
Kristen Silverberg
Deputy Assistant to the President for Domestic Policy

September 30, 2004

Kristen Silverberg

Hi. It's good to be here today to answer your questions on health care. Who has the first question?

Kathleen, from Odessa, TX writes:
The rates on our health insurance is being increased again. We have done what we can to afford a high deductible only insurance policy, but the monthly rate of over $700 just for my husband and I with no health issues has become unbearable. We own a small business and seem to have no recourse? Is there a solution in the making? Thank you for your reply in advance.

Kristen Silverberg
Kathleen – I’m glad you asked you that question. President Bush has proposed some very important steps to help small business owners and their employees afford health care.

First, President Bush supports Association Health Plans, which allow small businesses to band together and negotiate lower costs on behalf of the employees – just like large businesses do. The House of Representatives has passed good legislation creating Association Health Plans, but the legislation has stalled in the Senate. The President is committed to working with Congress to pass this legislation as soon as possible.

President Bush has also proposed to make it easier for owners and employees of small businesses to open Health Savings Accounts. With a Health Savings Account, you can have a low-cost high-deductible health plan for serious health expenses and you can set aside money tax-free for routine health care costs. Under the President’s plan, your monthly premium would also be tax deductible. And, the President would provide a tax rebate to a small business for the first $200 it contributes to an employees' health savings account.

(And, by the way, I am originally from Fort Davis, Texas – just down the road from Odessa!)

Veryl, from Ohio writes:
Mr. President, I live in the State of Ohio. I am calling in reference to the Medicare Act you approved along with Congress last year. The cancer care provisions of the Medicare Prescription Drug Bill were great for 2004. However, I Want to make you aware that effective January 1, 2005, the bill calls for deep cuts for cancer care dollars. If nothing is done, your cuts will impact the availability of cancer care for millions of Americans. I have seen your new Health Care commercial and notice that you discuss everything but cancer care and cancer cuts, but I urge you to address this issue and please dont let these cuts take place in 2005.

Kristen Silverberg
Veryl, thank you for raising this important issue.

The President is committed to preserving and expanding community-based cancer care. For years, cancer patients covered by Medicare (and taxpayers) have been overcharged for cancer drugs. The Administration has been very concerned about this practice because it costs seniors and taxpayers billions in excess charges.

But while Medicare overpays for cancer drugs, it underpays physicians for the cost of administering these drugs to patients. The Medicare bill that the President signed last year eliminated overpayments to physicians for drugs but increased payments to doctors for treating cancer patients. By doing these reforms in a balanced way, we are confident that we can preserve access to care for patients.

I will also add that the President has committed his Administration to support research into possible treatments or cures for cancer. By the end of this term he will have increased federal support for cancer research by $1.5 billion.

The National Cancer Institute has announced a new $144 million, five-year initiative to apply nanotechnology (devices so small they are measured on a molecular scale) to cancer. And the Food and Drug Administration is creating a new Cancer Office to accelerate approval of drugs and therapies to diagnose, treat, and prevent cancer.

Steve, from Woodinville, Wa writes:
Mr President, A growing crisis in this country is the ever-increasing cost of health care.

Although my wife and I are fortunate enough to have a household income of more than $100,000, the cost of health insurance, in particular, has become a major expense.

We are both self employed, so we have to pay for our coverage in full.

Over the last several years our premiums have increased substantially from year to year with no relief in sight.

While everyone seems to agree that health costs are a problem, I don't get the feeling that this country's leadership has shown the courage to tackle this problem and come to a workable solution.

If nothing is done soon, only the elite will be able to afford health care.

Thank you for your time.

Kristen Silverberg
President Bush believes it’s important to address the root causes of high health care costs. Health care costs have been rising steadily for decades. This year, for the first time in seven years, the rate of premium increases slowed, but to bring down costs we will need to ensure a more competitive, consumer-driven health care market.

For example, the President took important steps to lower the cost of prescription drugs. As you know, he signed Medicare legislation that makes drug coverage available to seniors. And, he has implemented reforms to make generic drugs more readily available to consumers, which will save consumers about $35 billion over ten years.

In addition, the President has proposed reform of the medical liability system. Excessive litigation costs Americans between $60 to $110 billion a year in higher health care costs. The high cost of liability insurance is forcing some doctors to leave the practice of medicine. The President believes that reasonable litigation reform will bring down costs for consumers, ensure that patients who are injured are compensated quickly and fairly, and allow physicians to stay in practice.

Finally, the President has proposed a plan to bring modern information technology to hospitals and doctors offices. Information technology – things like individual computerized medical records – can reduce medical errors, prevent duplicative or unnecessary treatments, and eliminate administrative expenses.

Brenda, from Las Cruces, NM writes:
My husband is a veteran, having served 20 years in the U.S. Air Force. As you are undoubtedly aware, the VA healthcare system is in chaos. Given the overall poor quality of care, the extended wait times (up to a year) to get an appointment, and the fact that veterans must sometimes travel hundreds of miles to a VA hospital or clinic, has there been any discussion about extending veterans' benefits so that they can receive care from their local doctors and hospitals? I find it unconscionable that illegal aliens receive free care locally from hospitals and clinics, but veterans are left to fend for themselves.

Kristen Silverberg
Brenda, thank you for writing.

President Bush believes in honoring our nation’s veterans, and an important part of our commitment to veterans is improving the health services provided by the Veterans Administration.

To improve the quality of veterans' health care, President Bush’s four budgets have provided a more than 40 percent increase in funding for veterans' medical care coverage. (In fact, in just four years he has increased funding twice as much as it was increased in the previous eight.) These budgets have allowed the VA to enroll 2.5 million more veterans in health care services, increase outpatient visits from 44 million to 54 million, and increase the number of prescriptions filled from 98 million in 2001 to 116 million. Under the President's leadership, 194 new community-based clinics have been opened and are now providing care to veterans. In addition, the list of veterans waiting more than six months for basic medical care, which peaked at 300,000, will be virtually eliminated.

To modernize VA facilities and provide more convenient care, his Administration is implementing the CARES plan ("CARES" stands for Capital Asset Realignment for Enhanced Services). This plan will build new hospitals, replace outdated facilities, and provide more outpatient services for veterans. One important goal of the CARES plan is to ensure that the vast majority of veterans are within 30 miles of a VA community-based outpatient clinic or similar facility. The President has committed $1.5 billion in the FY 2004 and FY 2005 budgets for this process, and additional funding will be requested in the future.

Thank you again for writing.

Mark, from Santa Fe writes:
In his convention address in New York, President Bush announced a new $1 billion initiative to enroll "millions of poor children" in two popular government health programs. But next week, the Bush administration plans to return $1.1 billion in unspent children's health funds to the U.S. Treasury, making his convention promise a financial wash at best.

Kristen Silverberg
Mark, thank you for raising the question. There is some misinformation about the Administration’s proposal. I’m glad to have the chance to address it.

Under existing law, which was passed in 1997, funds that are not used by states for SCHIP (State Children's Health Insurance Program) for several years revert to the Treasury. These excess funds result from the fact that there are millions of children who are eligible to be insured under SCHIP, but are not yet enrolled. For example, next year $10.8 billion in federal funds will be available to states for SCHIP coverage, but States anticipate spending only $5.3 billion.

States have been unable to spend $1.1 billion in funds from 1998, 1999 and 2000. This money will revert to the Treasury unless Congress acts, but the Administration is working with Congress to change the law. To ensure that, in the meantime, no State runs short of funds, Secretary Thompson has announced that he will provide additional funds from a separate pool to the few States that need more money in the new fiscal year.

The President believes that, instead of returning money to the Treasury, we should use it to help States enroll more children. Since 2001, we’ve made a great deal of progress – there are 2.5 million more children enrolled now than when the President took office – but there is still work to do. President Bush has proposed to target over $1 billion to enlist the help of community groups, faith-based organizations, states and schools in efforts to enroll eligible children in SCHIP. The President’s Cover the Kids Campaign will reach families during the course of their everyday lives, and through their friends and neighbors, giving us a better chance of getting their children registered for health coverage. Instead of sticking with the status quo, and being left each year with unspent funds and unenrolled children, the President thinks it makes good sense to give families the assistance they need in enrolling their children.

Christina, from Boone County, KY writes:
I work in our local hospital and everyday we have elderly people coming into the hospital with admissions that could have been prevented if they did not have to skimp on their medications. So many of them can not afford their monthly Rx that they cut them in half and not get the total daily dosage needed for their aliment. How do you address this concern and what is the White House doing about it? These people need our help just as much as those people across the world that we are funding food and medications.

Kristen Silverberg
Christina, you’ve raised a very important issue.

Most seniors have prescription drug coverage – through a former employer, Medicaid, or some other source, but millions have had to make due without it. That is why President Bush worked closely with Members of both parties in Congress to pass the new Medicare legislation, which will deliver a new drug benefit to 40 million seniors and people with disabilities. The full benefit takes effect in January 2006, but seniors are already benefiting from the Medicare-approved prescription drug discount cards. Card sponsors can charge up to $30 for a card, but several charge less and some are free. The savings from these cards can be significant and we expect competition among sponsors to drive prices down even further.

Any senior can sign up for a card by logging onto or calling 1-800-MEDICARE (1-800-633-4227). The senior should have a list of the prescription medicines she uses and will be asked for her zip code, how far she is willing to travel to a drug store, and information about her income, which will determine whether she is eligible for $600 in cash assistance for her medicines in addition to the discounts.

Does this answer your question? If not, will you email us back? -Kristen

Lanette, from Hannibal, Missouri writes:
Why can't health care costs be alleviated by ALL medical costs, including insurance premiums, deductibles, co-pays and prescriptions be a tax deduction? The expense could be deducted from the taxpayers gross income. THerefore tax liability is less and monthly expendable cash is increased.

Kristen Silverberg
Actually, that’s just what President Bush has proposed to do through his Health Savings Account proposal. Today, if you receive your health insurance through your employer, the employer receives a tax deduction for its contribution to purchasing your health plan. But if you buy your own health insurance individually, you don’t receive the same tax benefit.

The President signed into law a measure that allows individuals to open Health Savings Accounts. The person purchases a low-cost, high-deductible health plan for major medical expenses, but can save tax-free for routine expenses, including co-pays or prescriptions. The President has now proposed to make the premiums for the health plan tax deductible, and to give small businesses a tax incentive to contribute to their employees’ Health Savings Accounts.

In addition to the tax savings, Health Savings Accounts offer an important additional benefit – you own and control them yourself. A worker who wants to change jobs does not need to worry about losing health coverage – the worker takes his Health Savings Account with him. And, with Health Savings Accounts, you don’t negotiate with an HMO over treatment – you and your doctor decide whether a treatment makes sense.

Thank you for asking the question.

Kevin, from Twin Cities writes:
Ms. Silverberg- I think the long-term solution to the "health care crisis" is to get people off the couch and encourage them to join a gym, take a walk or simply eat better. If we work to prevent health care problems, it stands to reason we won't have to spend as much to pay for things that could be easily avoided. Is the Administration considering pushing prevention as a factor in this solution? Maybe we could deduct what we pay to join a gym or health club from our federal income taxes - that would be great Thanks.

Kristen Silverberg
You are absolutely right, Kevin – prevention and fitness are really important. Exercise helps to bring down health care costs, and people who are physically healthy feel better and live longer!

Working in the White House, I have a lot of good role models, but especially the President. President Bush loves to exercise, even in the summer heat in Crawford.

To encourage other Americans to be physically active, the President launched the HealthierUS initiative, which challenges Americans to exercise, eat a nutritious diet, get preventative screenings, and avoid unhealthy activities. Studies show that a modest increase in exercise can reduce the risk and burden or chronic conditions like obesity, diabetes and asthma.

Paul, from Camillus, NY writes:
If it has been proven that most prescription drugs manufactured or sold in Canada meet most governmental standards for safety, why does the Administration still oppose their importation to this country? I believe

the Administration opposes reimportation because of the pharmaceutical industry's political contributions to the President's reelection campaign and because of the pharmaceutical industry's greed for maximized profits. Senior citizens, such as I will be in a few years should have this option available to them.

Kristen Silverberg
The Food and Drug Administration, which is charged with ensuring the safety of drugs used by U.S. consumers, continues to have serious concerns regarding the safety of drugs shipped from overseas. These concerns were raised during President Bush's Administration, as well as by President Clinton's.

As an example of the kinds of dangers posed by imported drugs, one recent FDA spot inspection of imported drugs found that 88% of the shipments contained unapproved medications. In their inspections, the FDA has found animal drugs shipped for human use, drug labels written in Chinese, and pills shipped from a Canadian website that were packaged in a Tupperware and turned out to be from India.

The Administration has established a task force led by the Surgeon General to look at whether importation can be done safely, and that Task Force is scheduled to report to Congress in December. In the meantime, the President signed into law a Medicare bill that is already reducing drug prices for millions of seniors. And, the President has implemented measures to facilitate access to generic drugs, which will save consumers at least $35b/10 yrs.

Liz, from San Jose Cali writes:
What is your stand on stem cell reasurch?

Kristen Silverberg
Liz -- Thank you for raising this important issue.

The President has committed his Administration to working to find treatments and cures for diabetes, Parkinsons and other devastating diseases. Since President Bush took office, he has fulfilled his commitment to complete the doubling of the budget for the National Institutes of Health (NIH).

As part of the President’s commitment to medical research, he decided in 2001 to provide federal funding – for the first time – to research using human embryonic stem cells (hESC). At that time, the President implemented ethical restrictions to ensure that federal funds are not used in research involving the further destruction of human embryos, although that research may be funded by the private sector. The principle that human embryos merit respect as a form of human life – and that the federal government should not encourage their destruction – has been adopted by Congress on a bipartisan basis since 1996.

Since the 2001 announcement, the NIH has provided over $35 million in funding for hESC research, and has provided grants to most of the established American scientists in this field. Scientists seeking federal funding have access to more than 3,500 sets of stem cells, derived from 22 separate stem cell lines, and more will be available in the future.

It also should be noted that there is a great deal of important stem cell work being done that does not require the destruction of a human embryo. Last year, the NIH funded $190 million in “adult” stem cell research on cells taken, for example, from a person’s bone marrow or placental tissue. This research continues to show great promise.

Embryonic stem cell research is still in its earliest stages and many basic studies will be required before we know whether it will result in any new treatments or cures for disease. To accelerate research, NIH has created a new National Embryonic Stem Cell Bank at the NIH to provide a ready source of embryonic stem cells to scientists. The NIH will also establish new Centers of Excellence for Translational Stem Cell Research with the goal of transforming knowledge about the properties of stem cells into useful therapies for specific diseases.

The President will continue to support promising areas of medical research, and looks forward to the medical breakthroughs that may arise from scientists’ ongoing efforts in this area.

Kristen Silverberg Thanks for your questions today! Tune in tomorrow to hear from Doug Badger, who will answer your questions on Medicare.