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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.

Alan Gilbert
Special Assistant to the President for Domestic Policy

January 27, 2005

Alan Gilbert

I'm grateful for this chance to answer questions and share with you the President's agenda to help all Americans gain access to affordable, high-quality health care. The President is doing several health care events this week on expanding coverage and health care information technology, so I hope for a chance to address those issues. Let's go straight to questions.

Angela, from Knoxville, Tennessee writes:
How may I find out more about grants for transitioning to electronic medical records? Thank you.

Alan Gilbert
That is a great question, Angela.

Today, the President announced that his budget for 2006 supports the use of health information technology by increasing funding to $125 million for demonstration projects that will help test the effectiveness of health IT and allow for widespread adoption in the health care industry. The budget is also proposing an additional $50 million for 2005 (in addition to the $50 million already appropriated by Congress for 2005) to support the use of health IT.

I encourage you to check out or contact the federal Agency for Health Care Research and Quality at or (301) 427-1364 to learn more about opportunities that could apply to you.

Vaasu, from California writes:
Why is the US one of the few developed countries in which not all citizens are guaranteed proper medical care? What is president Bush doing to ensure that every American is covered by healthcare?Thank you.

Alan Gilbert
Thank you for your question, Vaasu.

The President shares your goal that Americans have access to quality health care services, but he favors a system in which individuals keep more of their own resources and have the ability to make choices as to what providers and services are best for them. He doesn’t believe the role of the federal government is to control health care and ration the services Americans receive. His health care agenda consists of proposals to increase the availability of affordable coverage and to put control of health care decisions in the hands of patients and doctors; not government, insurance bureaucrats, or trial lawyers.

President Bush signed legislation creating Health Savings Accounts (HSAs), which allow you to save tax-free to pay for routine medical expenses or future health needs. He has called for Association Health Plans (AHPs) to help small businesses band together to negotiate for more affordable health coverage for employees and their families the way unions and large employers do now. The President believes we need common-sense reforms to fix the run-away costs of the medical liability system where frivolous law suits are forcing providers to practice defensive medicine and running more doctors out of the practice of health care, increasing costs for all.

The President also signed into law legislation to create the first Medicare prescription drug benefit available to 40 million seniors and disabled individuals. The new benefit will become available on January 1, 2006. Until that time, seniors have access to Medicare approved prescription drug discount cards, which will save them 15% - 30% off the retail price of most brand name drugs.

He has also implemented a new rule to strengthen the competition between generic and brand name pharmaceuticals, which is expected to save American consumers more than $35 billion over 10 years.

The President does believe the federal government has a role to provide a strong health care safety-net to our most vulnerable citizens. This is why he announced a goal to open or expand 1,200 new community health center sites to serve an additional 6.1 million people by 2006. Health centers provide primary and preventive care in rural and underserved communities regardless of an individual’s ability to pay. The President has recently expanded upon this goal by announcing that we will open new health centers in every poor county that needs one.

Daniel, from Lakeville, CT writes:
Hi, I am 14 years old and very interested in politics and such. My dad is a doctor and every year, he pays higher medical liability premiums. So that is a major concern for him. How is the president going to balance the need to help my dad with medical liability and to help keep docotds accountable for patients who do seriously get hurt by a bunch of bad apple doctors?

Alan Gilbert
Thanks for the question, Daniel. With a doctor for a father, and an interest in politics, you have the makings of a health care policy advisor. I’m sure you get lots of good first-hand perspective from your dad. As your father has probably told you, good doctors are targeted by frivolous and junk lawsuits. This raises medical liability premiums for all doctors, even those who have never been the target of a lawsuit. Ultimately, the availability of health care services in some communities is reduced. The President has met with many physicians who have been forced to leave their communities because of rising premiums.

The President has called to reform of the medical liability system so that trial lawyers are discouraged from filing frivolous and junk lawsuits in hopes of winning the litigation lottery. That way the legal system can be freed up to focus on ensuring appropriate damage awards for those who are truly victims of malpractice. The President also strongly believes that patients who have been truly injured should receive quick, unlimited compensation for their current and future economic damages such as wages, medical expenses, and the loss of ability to provide unpaid services like care for children or parents. In determining a plaintiff’s economic damages, juries can look at a plaintiff’s future income.

Bill, from Philadelphia, Pennsylvania writes:
Mr. Gilbert, I live just outside Philadelphia, Pennsylvania and the malpractice rates for doctors here have skyrocketed over the past few years. What does the President's plan entail for helping to limit these rates as well as frivolous lawsuits?

Alan Gilbert
Thanks for the question Bill. We’ve heard a lot from Pennsylvania and many other States across the country that are suffering from the sky-rocketing cost of medical lawsuit abuse. Far too often, good doctors are the target of frivolous and junk lawsuits. This raises the cost of medical liability insurance that doctors and other health care providers must have. Some providers have seen their rates increase so much that they can no longer afford to practice medicine or must move to another state with more sensible medical liability reform laws, leaving patients with fewer options for necessary medical services. These lawsuits also drive doctors to practice defensive medicine in which they order tests and procedures they would otherwise consider unnecessary, solely as a defense against a potential future lawsuit. This raises health care costs for all Americans by billions of dollars a year.

The President has called on Congress to pass common-sense medical liability reforms to increase access to health care and stop the rapidly rising costs associated with frivolous lawsuits. The President believes that non-economic damages and punitive damages should be held to a reasonable amount and that punitive damages should be available only in cases of egregious conduct. The President has also proposed measures to ensure that old cases cannot be brought years after an event, and that defendants pay judgments in proportion to their fault. These measures are based on reforms that have proven successful in California and now Congress must act.

Jane, from 16 Chapel Street, Spruce Pine, NC 28777 writes:
Is there legislation being considered to make mandatory mental health testing for all children in the U.S.? I am unaware of such, but was told that President Bush is in favor of this legislation. Would a medical doctor be required to submit findings on all minor patients? This doesn't sound like something the President would support. Please direct me to appropriate WEB sites so that I may inform myself. Thank you.

Alan Gilbert
Jane, thank you for writing. I am very happy to address this question. I’ve heard this a few times and can only guess that it is an internet rumor.

The President has not and will not propose or support any mandatory mental health screening for children or adults. He has said that people with mental illness deserve our understanding and care. We must encourage more Americans to understand mental illness and encourage those who need help to seek treatment that can work. The President believes, however, that screening programs should be optional and that any decisions regarding a child should be made with parental consent.

Jenny, from Milwaukee writes:
Mr. Gilbert,I am a 24-year old profession, having worked for the last two years at my first job after graduated from college. I pay about $60 a month for very, very basic health care for just myself.

I am not an expert at this medical insurance info at all--so in easy terms to understand, what exactly are Health Savings Accounts and how can they help me in the future?


Alan Gilbert
That’s a great question, Jenny.

In December 2003, President Bush signed legislation creating Health Savings Accounts (HSAs) as a new, affordable option in health care coverage. HSAs are tax-free savings accounts that anyone can establish when they purchase a low-premium, high-deductible policy to cover major medical expenses. Money that you save in the HSA, or that your employer contributes to the HSA, can be used to pay for routine medical expenses or saved for future health needs, while the major medical policy helps cover big expenses, like hospital stays. HSAs are owned by you so they are portable if you change jobs, and the money you save in that account rolls over year after year, tax-free. HSAs are consumer driven, meaning they give you more control over your own health care spending, because you can choose the provider and services you want without going through a health plan or government bureaucrat.

You can sign up for HSAs with banks, credit unions, insurance companies and other approved companies. Your employer may also set up a plan for employees as well.

The President also wants to allow individuals with HSAs to deduct the premiums they pay for their major medical polices from their income taxes, thus reducing the cost even more. In addition, to extend the benefits of HSAs to low-income families and individuals, the President proposes giving low-income families a $1,000 contribution made directly to their HSA, along with a $2,000 refundable tax credit to help purchase a policy to cover major medical expenses.

For more information, I encourage you to visit to get helpful background on HSAs and how to obtain them.

Rebecca, from Boston, MA writes:
Hi Alan, thanks for taking our questions I was excited to read that one of the President's goals for healthcare is to improve the information technology involved. I recently read in the Journal of the American Geriatric Society that many elders are misprescribed medications. Would this be the sort of error that the President's policies try to counteract? I'd very much appreciate it if you could elaborate on this part of the President's plan.

Alan Gilbert
Hi Rebecca. As a Louisiana native, I can’t imagine all that snow up there in Boston.

The President announced in 2004 an ambitious goal that most Americans should have an electronic medical record within 10 years. He believes that we can improve care and save lives when doctors, hospitals, and patients are able to share information privately, securely, and have it available to them where and when care is needed.

Earlier today, the President was in Cleveland to highlight the benefits of health IT in saving lives and improving the quality of care for all Americans. Medication and prescription errors are a large problem and definitely one of the things that the President’s initiative is designed to address. In fact, the President announced a new rule to help enable the availability of e-prescribing when the Medicare drug benefit begins in 2006. E-prescribing improves the quality and safety of patient care through reduced medication errors and monitoring of adverse drug reactions, and will increase the efficiency of doctor’s offices. As the President has said, it makes no sense to provide 21st century health care through a 19th century paper-based system.

Chris, from Virginia writes:
What steps is the government taking to assist families without health care coverage to vaccinate their children?

Alan Gilbert
Thanks for the question, Chris.

It is an important goal for this Nation to ensure that at least 90% of small children receive the full series of vaccines that are so vital to their health. The Federal Vaccines For Children (VFC) program provides all recommended childhood vaccines, free of charge, to Medicaid recipients, the uninsured, American Indians and Alaska Natives, and children whose health coverage does not include vaccinations. The President has proposed improving vaccine access for children by allowing underinsured children to receive VFC-funded vaccines at State and local health clinics, in addition to those currently available at federally qualified health centers. The Centers for Disease Control and Prevention (CDC) runs another program, known as Section 317, that provides funds for State immunization operational costs and many of the vaccines provided in public health clinics.

CDC has also, for the first time, created a stockpile of children’s influenza vaccine under the VFC program. This will provide rapid access for children in case of a vaccine shortage or heavy flu season.

Greg, from Bald Knob, AR writes:
Why does Medicare pay for my medicine while i am in the hospital but when i am at home they won't? It's health care in the hospital but not at home what is up with that

Alan Gilbert
Thank you for writing, Greg.

Though many seniors have prescription drug coverage through a former employer, Medicaid, or some other source, millions have had to make due without for decades. As the President has said, it makes no sense for Medicare to pay for extended hospital stays for surgery, but not for the prescription drugs that will eliminate the need for surgery. For example, ulcer surgery costs about $28,000 per patient, yet the drugs that prevent ulcers cost only about $500 a year.

That is why President Bush worked closely with members of both parties in Congress to pass the Medicare Modernization Act, which will deliver a new drug benefit to 40 million seniors and people with disabilities beginning in January 2006. Until that time seniors are benefiting from Medicare-approved prescription drug discount cards. The savings on medications from these cards can be significant and very helpful.

I encourage you to call 1-800-MEDICARE or visit to learn more about assistance that is available to you.

Frank, from Arizona writes:
Mr. Gilbert,My wife and I own a small, family-oriented business and we have 7 full time employees. We are committed to providing them with health insurance, but our premiums keep increasing every month it seems.

What are the President's plans to help small business owners such as myself and my wife? We strongly believe in helping our employees, but it is very difficult.

Alan Gilbert
Thanks for the great question Frank. The President believes small businesses like yours are the engine that drives our economy and I understand your desire to provide good health coverage to your employees.

The President recognizes that small business are facing increasing difficulty in being able to afford health coverage for their employees. More than half of the uninsured are small business employees. That is why President Bush has a comprehensive plan to help small businesses provide affordable high quality coverage to workers and their families.

The President has urged Congress to enact Association Health Plans (AHPs) to allow small businesses to join together across state lines to negotiate for more affordable coverage, like large employers and unions already do today. To help workers and their families afford better health care, the President also signed into law new Health Savings Accounts (HSAs) that offer a way for those with low-cost, high-deductible health plans to save tax free in a personal account for medical expenses. The President has proposed giving small business owners tax credits for contributions made into an employee’s HSA. Common-sense reforms like these will be great for small businesses. We also need to reform our medical liability laws to reduce frivolous and time-consuming lawsuits that are driving good doctors out of local communities and raising health care costs for all.

Alan Gilbert
I'm afraid that's all I have time for today. Thank you for all your insightful and well-informed questions. I hope this has helped you understand the President's health care agenda better and I look forward to another opportunity to chat with you.

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