Bush Speaks to Nation, Sets Presidential Agenda

After a five-week battle over Florida's 25 electoral votes, Texas Gov. George W. Bush (R) emerged victorious last night over rival Vice President Al Gore (D) and laid the foundation for his administration in his first speech as president-elect, the New York Times reports. "Together we will strengthen Medicare and a offer prescription drug coverage to all of our seniors," Bush vowed from the state House in Austin, Texas, adding, "During the fall campaign, we differed about details of these proposals -- but there was remarkable consensus about the important issues before us ... now it is time to find common ground and build consensus to make America a beacon of opportunity in the 21st century" (Bush speech text, New York Times, 12/14). Despite the "absence of a clear mandate," Bush hopes to "defy political gravity" and enact "undiluted" campaign proposals such as putting a "free-market stamp" on Medicare. Bush aides said, however, that the president-elect plans first to push his "Immediate Helping Hand" program that would "allow states to cover prescription drugs for poor senior citizens" (Allen, Washington Post, 12/14). Vice President-elect Richard Cheney also "signaled" that the Bush administration would "make early pushes" on prescription drugs (Davis/Murray, Wall Street Journal, 12/14). According to one GOP House leader, Bush should also expect to receive "broad support" for health care tax credits (Allen, Washington Post, 12/14). In addition, lawmakers predict that both parties will likely reach a compromise on a patients' rights bill, while a prescription drug benefit may prove "tougher" to pass. They also expect that Bush will delay plans to overhaul Medicare (Dewar/Pianin, Washington Post, 12/14).

Starting Small-Time?
Most analysts agreed that Bush, given the "realities of a divided nation" and the political climate on Capitol Hill, will have to "significantly trim" his larger proposals, including Medicare reform, but called prospects "brighter" for enacting a prescription drug benefit for seniors (Chen/Barabak, Los Angeles Times, 12/14). The Christian Science Monitor also points out that Bush will likely have to put Medicare "on the shelf -- at least for a while" -- and start with "widely popular" plans, such as expanding Medicaid to include coverage for legal immigrants and pregnant women (Dillin, Christian Science Monitor, 12/14). According to Stuart Rothenberg, editor of the Rothenberg Political Report, Bush should start with an issue that he can "clai[m] success with in Texas," such as a patients' rights bill, rather than "tinkering with proposals left simmering in Congress" (Heath, Austin American-Statesman, 12/14). However, Rep. Roy Blunt (R-Mo.), Bush's liaison to the House, disagreed, arguing that the president-elect "needs to move quickly" on Medicare. Bush advisers have discussed appointing a bipartisan commission to tackle Medicare, a move that Blunt claimed "has the potential to slow things down. A 'fast-track commission' is an oxymoron." But with the economy beginning to "slow," prospects of overhauling Medicare may have dimmed (Calmes/Seib, Wall Street Journal, 12/14).

Of Appointments and Allocations
The American-Statesman also reports that Bush will likely fill White House and cabinet posts with key Texas aides, governors "deeply involved" with his campaign and veterans of former President George Bush's administration. According to Hotline, Bush has considered Wisconsin Gov. Tommy Thompson (R), University of North Carolina Dean William Roper, former HCFA head Gail Wilensky, retiring Rep. Tom Coburn (R-Okla.) and Rep. Rick Lazio (R-N.Y.) for HHS secretary (Hotline, 12/13). He has also considered Sen. Bill Frist (R-Tenn.) for the position. In addition, HIAA President Chip Kahn may serve as Bush's HCFA administrator (Kaiser Daily Health Policy Report, 12/6). Meanwhile, the Bush camp has begun crafting a preliminary budget, placing "price tags" on the president-elect's campaign promises and "laying out his priorities." Many of Bush's programs, such as "Immediate Helping Hand," will not require full funding in the first year, but if he enacts Medicare reforms, the allocations could become "much bigger" (Davis/Murray, Wall Street Journal, 12/14).

Where He Stands
During the campaign, Bush outlined his positions and proposals on health care issues. A summary appears below:

• Medicare prescription drug benefit: Bush would introduce "Immediate Helping Hand," legislation that would give states $48 billion over four years in "direct support" to allow states to cover the full cost of prescription drug coverage for seniors with incomes at or below 135% of the poverty level and some of the cost of prescription drug coverage for seniors with incomes between 135% and 175% of the poverty level. The program would also cover any prescription drug costs beyond $6,000 per year (www.georgebush.com);
• The uninsured: Bush would offer a $2,000 health credit to families who do not qualify for Medicaid or other government assistance to allow them to purchase a "basic health insurance plan (www.georgewbush.com);
• Long term care: Bush would provide a 100% "above-the-line tax deduction" for any individual who does not already have long term care coverage. In addition, he would provide a tax exemption of $2,750 for each elderly spouse, parent or relative a caregiver tends to in his or her home (www.georgewbush.com);
• Safety net: Bush has proposed increasing the Community and Migrant Health Centers budget by $3.6 billion over five years to double the number of patients such clinics care for (www.georgewbush.com);
• Patients' rights: Bush would support a "limited" right to sue, but would not support a law that would "supersede" Texas' patients' rights law (Kaiser Daily Health Policy Report, 11/1);
• Research funding: Bush has pledged to boost NIH funding to $26.3 billion and to provide the National Cancer Institute with a $2.55 billion increase by 2003 (Gray Sheet, 10/2). He also said he would increase the overall NIH budget by an additional $67 billion over the next 10 years (Kaiser Daily Health Policy Report, 9/25);
• HIV/AIDS: Bush would "support significant government-funded research aimed at conquering" AIDS, as well as prevention "programs like the Ryan White Care Act" (Kaiser Daily HIV/AIDS Report, 10/12);
• Abortion: During the first presidential debate, Bush said he believes "abortions ought to be more rare in America. And I'm worried that [RU-486] will create more abortion." During the same debate, Bush said, "[E]very child born and unborn ought to be protected in law and welcomed in life. [W]e can find good common ground on issues like parental notification and parental consent." Bush also would ban "partial-birth" abortions (Kaiser Daily Reproductive Health Report, 10/4).