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Volume 35--Number 42
Pages 2065-2124
Week Ending Friday, October 22, 1999
Statement on the Vote in Indonesia To Accept the East Timor Referendum 

October 19, 1999

    I welcome the historic decision by the People's Consultative 
Assembly of Indonesia to accept the results of the August 30 referendum 
in East Timor. The assembly's unequivocal action shows respect for the 
will of the people of East Timor. It is also an important step forward 
in Indonesia's own democratic transformation, which the United States 
strongly supports.
    Of course, much work remains to make sure that East Timor's 
transition succeeds. In the wake of the assembly's decision, the United 
Nations must establish a transition administration leading to East 
Timor's full independence. And Indonesia must take the necessary steps 
to ensure the safe return of all displaced East Timorese, including 
allowing the international community full access to displaced persons in 
west Timor.
    The United States is committed to helping the people of East Timor 
not only obtain the legal recognition of independence but also develop 
the institutions they need to thrive as an independent state. We are 
equally determined to help Indonesia achieve its goal of lasting 
democracy and prosperity. Today's action will bring both goals closer to 

[Weekly Compilation of Presidential Documents]

[Page 2088-2089]
Monday, October 25, 1999
Volume 35--Number 42
Pages 2065-2124
Week Ending Friday, October 22, 1999
Statement on House Action on the ``Work Incentives Improvement Act''

October 19, 1999

    I am extremely pleased that the House, by an overwhelming bipartisan 
vote today, passed legislation that will remove barriers to work for 
Americans with disabilities. Today's impressive vote for the ``Work 
Incentives Improvement Act'' sends a strong signal that all Americans, 
including people with disabilities, should have the opportunity to work. 
Now I call on Congress to finish the job so more Americans can start to 
    My administration has helped create more than 19 million new jobs in 
the last 6\1/2\ years, and unemployment is at a 29-year low. Yet almost 
three out of four Americans with severe disabilities who want to work 
are not working. Since taking office, I have made empowering and 
promoting the independence of people with disabilities a priority. 
Central to this effort is taking down barriers to work for people with 
disabilities. One of the biggest barriers these Americans face is the 
fear of losing their health insurance when they get a job. Under current 
law, many people with disabilities cannot work and keep their Medicaid 
or Medicare coverage, creating a tremendous disincentive to work.
    The ``Work Incentives Improvement Act'' would help ensure that 
people with disabilities do not lose their health care when they gain a 
job. It would give workers with disabilities the option to buy into 
Medicaid and would extend Medicare coverage for people

[[Page 2089]]

with disabilities who return to work. The ``Work Incentives Improvement 
Act'' also modernizes the vocational rehabilitation system by creating a 
``ticket'' that enables an SSI or SSDI beneficiary to go to either a 
public or private provider of vocational rehabilitation.
    In my State of the Union Address, 9 months ago, I urged the Congress 
to make this historic legislation a top priority, and I fully funded it 
in the budget I sent to Congress. Like the House, the Senate has 
overwhelmingly passed the ``Work Incentives Improvement Act,'' thanks to 
the leadership of Senators Jeffords, Kennedy, Roth, and Moynihan. The 
bill that passed today has flaws. These include limitations on the 
health options and inadequate and problematic financing provisions, 
particularly one affecting student loans. I urge the Congress to address 
these issues this year and send me this legislation. Americans with 
disabilities who want to work should not have to wait any longer for 
that opportunity.

[Weekly Compilation of Presidential Documents]

[Page 2089]
Monday, October 25, 1999
Volume 35--Number 42
Pages 2065-2124
Week Ending Friday, October 22, 1999
Notice--Continuation of Emergency With Respect to Significant Narcotics 
Traffickers Centered in Colombia

October 19, 1999

    On October 21, 1995, by Executive Order 12978, I declared a national 
emergency to deal with the unusual and extraordinary threat to the 
national security, foreign policy, and economy of the United States 
constituted by the actions of significant foreign narcotics traffickers 
centered in Colombia, and the unparalleled violence, corruption, and 
harm that they cause in the United States and abroad. The order blocks 
all property and interests in property of foreign persons listed in an 
Annex to the order, as well as foreign persons determined to play a 
significant role in international narcotics trafficking centered in 
Colombia, to materially assist in, or provide financial or technological 
support for or goods or services in support of, the narcotics 
trafficking activities of persons designated in or pursuant to the 
order, or to be owned or controlled by, or to act for or on behalf of, 
persons designated in or pursuant to the order. The order also prohibits 
any transaction or dealing by United States persons or within the United 
States in such property or interests in property. Because the activities 
of significant narcotics traffickers centered in Colombia continue to 
threaten the national security, foreign policy, and economy of the 
United States and to cause unparalleled violence, corruption, and harm 
in the United States and abroad, the national emergency declared on 
October 21, 1995, and the measures adopted pursuant thereto to respond 
to that emergency, must continue in effect beyond October 21, 1999. 
Therefore, in accordance with section 202(d) of the National Emergencies 
Act (50 U.S.C. 1622(d)), I am continuing the national emergency for 1 
year with respect to significant narcotics traffickers centered in 
    This notice shall be published in the Federal Register and 
transmitted to the Congress.
                                            William J. Clinton
The White House,
October 19, 1999.

[Filed with the Office of the Federal Register, 12:16 p.m., October 19, 

Note: This notice was published in the Federal Register on October 20.

[Weekly Compilation of Presidential Documents]

[Page 2089-2090]
Monday, October 25, 1999
Volume 35--Number 42
Pages 2065-2124
Week Ending Friday, October 22, 1999
Message to the Congress on Continuation of the National Emergency With 
Respect to Significant Narcotics Traffickers Centered in Colombia

October 19, 1999

To the Congress of the United States:

    Section 202(d) of the National Emergencies Act (50 U.S.C. 1622(d)) 
provides for the automatic termination of a national emergency unless, 
prior to the anniversary date of its declaration, the President 
publishes in the Federal Register and transmits to the Congress a notice 
stating that the emergency is to continue in effect beyond the 
anniversary date. In accordance with this provision, I have sent the 
enclosed notice to the Federal Register for publication, stating that 

[[Page 2090]]

emergency declared with respect to significant narcotics traffickers 
centered in Colombia is to continue in effect for 1 year beyond October 
21, 1999.
    The circumstances that led to the declaration on October 21, 1995, 
of a national emergency have not been resolved. The actions of 
significant narcotics traffickers centered in Colombia continue to pose 
an unusual and extraordinary threat to the national security, foreign 
policy, and economy of the United States and to cause unparalleled 
violence, corruption, and harm in the United States and abroad. For 
these reasons, I have determined that it is necessary to maintain in 
force the broad authorities necessary to maintain economic pressure on 
significant narcotics traffickers centered in Colombia by blocking their 
property subject to the jurisdiction of the United States and by 
depriving them of access to the United States market and financial 
                                            William J. Clinton
The White House,
October 19, 1999.

[Weekly Compilation of Presidential Documents]

[Page 2090-2091]
Monday, October 25, 1999
Volume 35--Number 42
Pages 2065-2124
Week Ending Friday, October 22, 1999
Letter to Congressional Leaders on Medicare Reform

October 19, 1999

Dear Mr. Chairman:  (Dear Senator Moynihan:)

    It was a pleasure to meet with you and Senator Moynihan earlier this 
month to discuss our mutual commitment to strengthening and modernizing 
Medicare. It continues to be my hope that the Congress will take action 
this year to, at minimum, make a downpayment on needed reforms of the 
program. I look forward to working with you toward that end.
    In 1997, the Medicare trustees projected that Medicare would become 
insolvent in 2001. Working together across party lines, the Congress 
passed and I enacted important reforms that contributed towards 
extending the life of the Medicare trust fund to 2015. As with any major 
legislation, the Balanced Budget Act (BBA) included some policies that 
are flawed or have had unintended consequences that are posing immediate 
problems to some providers and beneficiaries. In addition, the program 
faces the long-term demographic and health care challenges that will 
inevitably result as the baby-boom generation ages into Medicare. As we 
worked together in 1997 to address the immediate threat to Medicare, we 
must work together now to address its short-term and long-term 
    Preparing and strengthening Medicare for the next century is and 
will continue to be a top priority for my Administration. For this 
reason, I proposed a plan that makes the program more competitive and 
efficient, modernizes its benefits to include the provision of a long-
overdue prescription drug benefit, and dedicates a portion of the 
surplus to help secure program solvency for at least another 10 years. 
However, I also share your belief that we need to take prompt action--
whether in the context of broader or more limited reforms--to moderate 
the excessive provider payment reductions in the BBA of 1997. I believe 
that legislative modifications in this regard should be paid for and 
should not undermine the solvency of the Medicare trust fund.
    You have requested a summary of the administrative actions that I 
plan to take to moderate the impact of the BBA. In the letter that you 
sent to me last Thursday, you also asked about four specific issues 
related to payment for hospital outpatient departments, managed care, 
skilled nursing facilities, and disproportionate share hospitals.
    Attached is a summary of the over 25 administrative actions that my 
Administration is currently implementing or will take to address 
Medicare provider payment issues. The Department of Health and Human 
Services is taking virtually all the administrative actions possible 
under the law that have a policy justification, which will accrue to the 
benefit of hospitals, nursing homes, home health agencies, and other 
    We are finishing our review of our administrative authority to 
address the 5.7 percent reduction in hospital outpatient department 
payments. We believe that the Congressional intent was to not impose an 
additional reduction in aggregate payments for hospitals and I favor a 
policy that achieves this goal. The

[[Page 2091]]

enactment of clarifying language on this subject would be useful in 
making clear Congressional intent with regard to this issue. I have 
attached a letter from Office of Management and Budget Director Jack 
Lew, which was sent at the request of Congressman Bill Thomas, detailing 
how such language would be scored by OMB.
    With regards to managed care, we share your commitment to expanding 
choice and achieving stability in the Medicare+Choice marketplace. The 
BBA required that payments to managed care plans be risk adjusted. To 
ease the transition to this system, we proposed a 5-year, gradual phase-
in of the risk adjustment system. This phase-in forgoes approximately 
$4.5 billion in payment reductions that would have occurred if risk 
adjustment were fully implemented immediately. The Medicare Payment 
Advisory Commission and other experts support my Administration's risk 
adjustment plan. Consistent with this position, most policy experts 
believe that a further slowdown of its implementation is unwarranted. 
However, we remain committed to making any and all changes that improve 
its methodology. Moreover, as you know, any administrative and 
legislative changes that increase payment rates to providers in the fee-
for-service program will also increase payments to managed care plans.
    On the issue of skilled nursing facilities, we agree that nursing 
home payments for the sickest Medicare beneficiaries are not adequate. I 
intend to take all actions possible to address this. Administratively, 
we can and will use the results of a study that is about to be completed 
to adjust payments as soon as possible. While we believe that these 
adjustments must be budget neutral, we are continuing to review whether 
we have additional administrative authority in this area.
    Finally, it appears that there has been confusion about the current 
policy for disproportionate share hospital (DSH) payments. Hospitals 
across a considerable number of states have misconstrued how to 
calculate DSH payments. The Department of Health and Human Services 
(HHS) has since concluded that this resulted from unclear guidance. 
Thus, as reported last Friday, HHS will not recoup pass overpayments and 
will issue new, clearer guidance as soon as possible.

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