Page 1: May 1, 1992 TO: SENATOR DOLE FROM: SHEILA BURKE SUBJECT: MEETING WITH SENATOR MITCHELL · Universal access and controls on health care costs are going to major issues in both the Presidential race as well as state races. · We're not likely to be able to resolve the fundamental battle between mandates and incentives( pay or play vs. credits) this year. · I think we can all agree that our current system falls far short of the American people's expectations. We have to start solving these problems by looking towards the areas of consensus, rather than spend endless hours debating our differences. · In the past six months or so, there appears to be growing consensus in the area of small market reform. This is a good starting point. It will expand access to many of those who are working in small businesses or who cannot change jobs for fear of losing coverage. · No one seriously believes that passage of a small market reform bill will end the debate -- but it could actually do some good in making insurance more affordable and available. · Under our scenario everyone loses something -- -- you don't get pay/play -- we don't get tax credits or tort reform -- The Administration gets nothing -- Neither of us gets Medicaid expansions and nobody gives up the issue. · Areas of possible negotiations: · Tax deduction for self employed · Cost Item · Limits on pre-existing conditions and cancellation provisions. · Rating Bands on premiums · Benefit standards · Anti-managed care laws · Pre-exemption of mandated benefits. Page 2: GEORGE J. MITCHELL MAINE United States Senate Office of the Majority Leader Washington, DC 20510-7010 April 29, 1992 The Honorable Bob Dole Republican Leader United States Senate Washington, DC 20510 Dear Bob: Thank you for your letter of April 27, cosigned by several other Senators, regarding health care. I appreciate the opportunity to meet with you at the earliest opportunity on this important subject. Therefore, I suggest a meeting with you and your colleagues this Friday, at 1:45 PM, in my office in the Capitol. Sincerely, (signature) George J. Mitchell cc: Senator Alan Simpson Senator Orrin Hatch Senator Nancy Kassebaum Senator Christopher Bond Senator Larry Presler Senator Chuck Grassley (handwritten: wcb) Senator John Chafee (handwritten: OK, Mo, Judy) Senator John Danforth (handwritten: Judy) Senator John McCain Senator Dave Durenberger Senator James Jeffords Senator Robert Kasten handwritten notes on page: 46117 10:30-11:30 BOND - POTUS 1:30 Page 3: 04/28/92 13:56 202 224 4262 SEN. CHAFEE 002 United States Senate April 27, 1992 JOHN H. CHAFEE RHODE ISLAND COMMITTEE ON FINANCE RANKING MEMBER, COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS THE SENATE ARMS CONTROL OBSERVER GROUP SELECT COMMITTEE ON INTELLIGENCE WASHINGTON OFFICE: WASHINGTON, DC 20510 (202) 224-2921 TDD: (202) 224-7617 PROVIDENCE OFFICE: 301 JOHN O. PASTORE FEDERAL BUILDING KENNEDY PLAZA PROVIDENCE, RI 02903 (401) 528-5294 TOLL FREE NUMBER IN RHODE ISLAND 1-800-662-5188 The Honorable George J. Mitchell Majority Leader United States Senate Washington, D.C. 20510 Dear George: During recent debate on the budget resolution, considerable time was spent on the issue of health costs and the need for reform of our health care system. During that discussion you stated your desire to end the partisan politics surrounding health care reform and to begin working together on a solution. We are writing to ask that we join together. We strongly believe in the need for health care reform. While there are many differences of opinion about some aspects of reform, there is much more agreement than is commonly acknowledged. We are encouraged by the striking similarities between provisions in the recent proposal outlined by the President, the bill introduced by the Republican Health Care Task Force, the bill introduced by the Chairman of the Finance Committee, and the proposal introduced by the Senate Democratic Leadership. If one examines the elements of each of those proposals, it appears we all agree on a number of critical steps that can be taken to slow the rate of growth in our health care expenditures and to ensure that more Americans have health care coverage. These steps include the following: *insurance market reform; *small group purchasing; *community health center and national health service corps expansion; *encouraging the use of managed care; *preemption of state mandated benefit laws; *changes in the tax code to address inequities -- specifically allowing the self-employed and individuals purchasing health care to deduct either the full amount or some portion of the cost of their health insurance; *state experimentation; *medical liability reform; *reduction in administrative costs; *encouraging primary and preventive care; *expanding outcomes research Page 4: 04/28/92 13:57 202 224 4262 SEN. CHAFEE 003 The Honorable George J. Mitchell April 27, 1992 Page 2 It is clear that reforming our health care system is the most critical challenge facing our nation in this decade. Our economic prosperity and our ability to control federal spending hinge on whether we can solve the health care puzzle. Crafting a bipartisan agreement on the above issues -- as well as any others upon which we can agree -- certainly would make it possible for us to move ahead in the near future with some significant and positive steps to reform our system. We hope that neither party will allow the temptation of using this issue as a campaign issue to take priority over enacting something that will at least move us closer to the goal of reducing costs and ensuring that all Americans have access to health care. Thus, we are writing to ask that you join us in an effort to craft a bipartisan proposal. We propose to begin meeting this week at your convenience. Sincerely, (illegible signature) John Chafee (signature) (illegible signature) (illegible signature) (illegible signature) John McCain (signature) Nancy Kassebaum (signature) Dave Durenburger (signature) (illegible) Bond (signature) (illegible) Jeffords (signature) Larry Pressler (signature) (illegible signature) Chuck Grassley (signature) Page 5: SCHEDULE FOR FRI, MAY 1 9:10-9:30 Radisson Hotel, Plaza B, Alexandria SPEAK - American Speech-Language-Hearing Association's Conference 10:00 SD-215 FIN COMM - Subc on Deficits - "Soviet debt" 10:15 S-230 DROP BY - Mira mtg. w/Tom Merrick, Group VP of Fluor Corp, & Pete Velde 10:30 S-230 PHOTO & PHONES w/24 5th graders from Barstow Elementary in Johnson County; (David); & w/Wayne & Janel Coffman, M/M Kerl Niebrugge f/Baldwin City, & w/Alan Niebrugge f/Louisburg (Bob W.) 11:15 S-230 KS radio conference call (Clarkson) 1:00 S-230 mtg. w/John H. Harms (Walt) (OVER) handwritten: 1:45 Mitchell et al 6:30-10:30 Grand Hyatt, Independence Ballroom ??? 45th Annual Horatio Alger Awards Dinner (BLACK TIE) (reception from 5:15-6:15 p.m.) Page 6: BOB DOLE KANSAS United States Senate OFFICE OF THE REPUBLICAN LEADER WASHINGTON, DC 20510-7020 TO: SENATOR DOLE FROM: SHEILA BURKE RE: MEETING ON HEALTH CARE PROPOSAL Senator Mitchell has suggested a meeting tomorrow at 1:45 p.m. Ok to meeting? yes (check mark) no Include other members: yes (check mark) no handwritten on page: pre-mtg in S-230 at 1:15 Page 7: GEORGE J. MITCHELL MAINE United States Senate Office of the Majority Leader Washington, DC 20510-7010 April 29, 1992 The Honorable Bob Dole Republican Leader United States Senate Washington, DC 20510 Dear Bob: Thank you for your letter of April 27, cosigned by several other Senators, regarding health care. I appreciate the opportunity to meet with you at the earliest opportunity on this important subject. Therefore, I suggest a meeting with you and your colleagues this Friday, at 1:45 PM (underlined), in my office in the Capitol. Sincerely, (signature) George J. Mitchell cc: Senator Alan Simpson Senator Orrin Hatch Senator Nancy Kassebaum Senator Christopher Bond Senator Larry Pressler Senator Chuck Grassley Senator John Chafee Senator John Danforth Senator John McCain Senator Dave Durenberger Senator James Jeffords Senator Robert Kasten Page 8: 04/28/92 13:56 202 224 4262 SEN. CHAFEE 002 JOHN H. CHAFEE RHODE ISLAND COMMITTEE ON FINANCE RANKING MEMBER, COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS THE SENATE ARMS CONTROL OBSERVER GROUP SELECT COMMITTEE ON INTELLIGENCE WASHINGTON OFFICE: WASHINGTON, DC 20510 (202) 224-2921 TDD: (202) 224-7517 PROVIDENCE OFFICE: 301 JOHN O. PASTORE FEDERAL BUILDING KENNEDY PLAZA PROVIDENCE, RI 02903 (401) 528-5294 TOLL FREE NUMBER IN RHODE ISLAND 1-800-662-5188 United States Senate April 27, 1992 The Honorable George J. Mitchell Majority Leader United States Senate Washington, D.C. 20510 Dear George: During recent debate on the budget resolution, considerable time was spent on the issue of health costs and the need for reform of our health care system. During that discussion you stated your desire to end the partisan politics surrounding health care reform and to begin working together on a solution. We are writing to ask that we join together. We strongly believe in the need for health care reform. While there are many differences of opinion about some aspects of reform, there is much more agreement than is commonly acknowledged. We are encouraged by the striking similarities between provisions in the recent proposal outlined by the President, the bill introduced by the Republican Health Care Task Force, the bill introduced by the Chairman of the Finance Committee, and the proposal introduced by the Senate Democratic Leadership. If one examines the elements of each of those proposals, it appears we all agree on a number of critical steps that can be taken to slow the rate of growth in our health care expenditures and to ensure that more Americans have health care coverage. These steps include the following: *insurance market reform; *small group purchasing; *community health center and national health service corps expansion; *encouraging the use of managed care; *preemption of state mandated benefit laws; *changes in the tax code to address inequities -- specifically allowing the self-employed and individuals purchasing health care to deduct either the full amount or some portion of the cost of their health insurance; *state experimentation; *medical liability reform; *reduction in administrative costs; *encouraging primary and preventive care; *expanding outcomes research Page 9: 04/28/92 13:57 202 224 4262 SEN. CHAFEE 003 The Honorable George J. Mitchell April 27, 1992 Page 2 It is clear that reforming our health care system is the most critical challenge facing our nation in this decade. Our economic prosperity and our ability to control federal spending hinge on whether we can solve the health care puzzle. Crafting a bipartisan agreement on the above issues -- as well as any others upon which we can agree -- certainly would make it possible for us to move ahead in the near future with some significant and positive steps to reform our system. We hope that neither party will allow the temptation of using this issue as a campaign issue to take priority over enacting something that will at least move us closer to the goal of reducing costs and ensuring that all Americans have access to health care. Thus, we are writing to ask that you join us in an effort to craft a bipartisan proposal. We propose to begin meeting this week at your convenience. Sincerely, (illegible signature) John Chafee (signature) (illegible signature) (illegible signature) (illegible signature) John McCain (signature) Nancy Kassebaum (signature) Dave Durenburger (signature) (illegible) Bond (signature) (illegible) Jeffords (signature) Larry Pressler (signature) (illegible signature) Chuck Grassley (signature)