[THIS IS THE DAILY BRIEFING FROM THE WHITE HOUSE TO ITS OFFICIALS AND OTHER SUPPORTERS OF ITS HEALTH-REFORM PROGRAM. IT PROVIDES AN INSIDE LOOK AT HOW THE ADMINISTRATION IS PROMOTING ITS PLAN. THIS ITEM WILL ALWAYS HAVE THE SAME SUBJECT LINE (WITH DIFFERENT DATES) SO YOU CAN EASILY SKIP IT IF YOU DO NOT WISH TO READ IT.] E X E C U T I V E O F F I C E O F T H E P R E S I D E N T 21-Nov-1993 06:39pm The White House Health Care Reform Today November 22, 1993 * The Chairman of the President's National Economic Council confirmed a study by the Center on Budget and Policy Priorities that shows deficit reduction legislation proposed by Reps. Penny and Kasich includes an unfunded mandate that would cost the state budgets $5.1 billion over the next five years. * Robert Rubin, Chairman of the NEC, said the study is accurate it points out clearly that under Penny-Kasich, states would be forced to pick up additional Medicare costs. The study says: "The largest Medicare savings provision in the Penny-Kasich plan requires Medicare beneficiaries to pay 20 percent of the cost of home health services. The provision is designed so that beneficiaries under 150 percent of the poverty line will not have to pay this new charge. The mechanism the Penny-Kasich plan uses to achieve the result imposes a new $5 billion unfunded mandate on the states." * Rubin confirmed the report language that says: "The impact of this new mandate on state budgets would be especially troublesome since states would have little opportunity to control its costs. States have no authority to set or restrain Medicare home health care charges. Nor do they have any authority to take action affecting utilization of Medicare home health services. This is a serious concern for states because Medicare home health costs have been rising rapidly. >From 1988 to 1991, Medicare expenditures for home health services rose 69%. * The costs to state treasuries would be extremely large -- $5.1 billion over five years. Moreover, this cost would grow rapidly. The CBO figure show that the cost of this unfunded mandates would jump from $550 million in fiscal year 1994 to $1.3 billion in fiscal year 1998. * State budgets have been increasingly squeezed in recent years by rapidly rising Medicaid costs. State Medicaid spending increased in 1992 by 27.9 percent over the previous year's level. * Fifteen states will incur costs of more than 100 million over the next five years as a result of this mandate. Over half of all states will incur additional costs of more than $50 million over the five-year period. The costs of this mandate will climb steadily over time, placing increasing pressure on state budgets.