Annual Immunization Report On Children Enrolled In Child Care: Fill & Download for Free

Bill did a ton of positive stuff. The energy this guy had was amazing. I regret never meeting him but my girlfriend and an employee did. Right on the street. Just walked up and said hi, I’m Bill, nice city you’ve got here.Most of this stuff was good. Bad? Maybe didn’t intervene in Rwanda where the mass killings took place.The Clinton Presidency:1993January 22Abolished Restrictions on Medical Research and the Right to ChooseAs his first executive actions, President Clinton revoked the Gag Rule, which prohibited abortion counseling in clinics that receive federal funding to serve low-income patients. He also revoked restrictions on a woman's legal right to privately funded abortion services in military hospitals, restrictions on the import of RU-486, and restrictions on the award of international family planning grants (the "Mexico City Policy"). The President also lifted the moratorium on federal funding for research involving fetal tissue, allowing progress on research into treatments for Parkinson's disease, Alzheimer's, diabetes and leukemia. (Executive Memoranda, 1/22/93)February 1Helped States Take the First Steps Toward Welfare ReformPresident Clinton ordered the Federal Government to make it easier for states to receive waivers from government regulations in order to implement innovative welfare reform projects. Between 1993 and the signing of the Welfare Reform bill in 1996, the Administration granted waivers to a record 43 states. Those waivers laid the foundation of the new welfare reform law by strengthening work requirements, time-limiting assistance and demanding parental responsibility. (Presidential Directives 2/1/93)February 5Family and Medical Leave ActThe Family & Medical Leave Act — the first piece of legislation the President signed into law — has enabled millions of workers to take up to 12 weeks unpaid leave to care for a new baby or ailing family member without jeopardizing their job. The previous administration vetoed the bill twice. (PL 103-3, signed 2/5/93)March 3"Reinventing Government" Initiative LaunchedPresident Clinton asked Vice President Gore to head the National Performance Review aimed at making government work better for less. The Vice President's Reinventing Government Initiative has resulted in 377,000 fewer civilian employees in the federal government — the lowest level since the Kennedy Administration — and reduced federal spending as a share of the economy from 22.2 percent in 1992 to a projected 18.5 percent in 2000, the lowest since 1966.April 1Childhood ImmunizationsThe President launched a major childhood immunization effort to increase the number of children who were being immunized. Since 1993, childhood immunization rates have reached all-time highs, with 90 percent or more of America's toddlers receiving critical vaccines for children by age 2. Vaccination levels are nearly the same for preschool children of all racial and ethnic groups, narrowing a gap estimated to be as wide as 26 percentage points a generation ago.May 20Motor Voter Registration SignedThe Clinton Administration made it easier for millions of Americans to register to vote by allowing registration at the same time they get a driver's license. The Motor Voter law led to the registration of more than 28 million new voters, more registered voters than the passage of the 26th Amendment, which lowered the voting age to 18 years. (PL 103-31, signed 5/20/93).August 10Clinton-Gore Deficit Reduction Plan EnactedPassed without a single Republican vote, the Clinton-Gore Administration's economic plan established fiscal discipline by slashing the deficit in half — the largest deficit reduction plan in history — while making important investments in our economic future, including education, health care, and science and technology research. This legislation also extended the life of the Medicare Trust Fund by three years. Fiscal discipline established by the Clinton-Gore Administration has turned the largest deficits in our country's history into the largest surplus. (PL 103-66, signed 8/10/93)Earned Income Tax Credit Expansion/Working Family Tax CutPresident Clinton succeeded in passing an expansion of the Earned Income Tax Credit, giving a tax cut to 15 million of the hardest-pressed American workers. In 1999, the EITC lifted 4.1 million people out of poverty — nearly double the number lifted out of poverty by the EITC in 1993. (PL 103-66, signed 8/10/93).Student Loan ReformThe Clinton-Gore Administration created the Direct Student Loan Program, which cut red tape and administrative costs by eliminating subsidies and bureaucracy in the Student Loan Program. The program has saved taxpayers $4 billion since 1993 and allowed interest rate reductions for students. (PL 103-66, signed 8/10/93)Empowerment Zone/Enterprise Communities ProgramCreated nine Empowerment Zones and 95 Enterprise Communities with tax incentives and $100 million per EZ in discretionary investment dollars to spur local community planning and economic growth in distressed communities. At the President's request, Congress expanded the program in 1994, 1997, and again in 2000. To date, the EZ program has leveraged over $10 million in additional private investment into EZs. The EZ program represents the most ambitious incentives program ever offered by the federal government to promote private sector investment in distressed areas in America.Childhood Immunization InitiativeIn 1992, less than 60 percent of two-year-olds were fully immunized — the third lowest rate in the Western Hemisphere. The Clinton-Gore Economic Plan contained investments to guarantee the health of children and prevent the easily avoidable costs of preventable childhood diseases. Today, the nation's overall immunization rate for preschool children is the highest ever recorded.September 21AmeriCorps Community Service Initiative EnactedAmeriCorps allows individuals to serve communities across the country while earning money for college or skills training programs. Since its inception, 150,000 volunteers have participated in AmeriCorps; that means that more people have enrolled in this Clinton Administration initiative in its first five years than did in the Peace Corps' first 20 years. (PL 103-82, signed 9/21/93)November 30Brady Act SignedAfter seven years of debate under previous administrations, the President signed legislation requiring a background check before the purchase of a handgun and establishing a National Instant Check System. Since its enactment, the Brady Law has helped to prevent a total of more than 600,000 felons, fugitives, domestic abusers, and other prohibited purchasers from buying guns. Since 1992, the gun-related crime rate has declined by 40 percent. (PL 103-159, signed 11/30/93)December 8NAFTA RatifiedPresident Clinton worked to pass bipartisan legislation implementing the North American Free Trade Agreement, creating the world's largest free trade zone. Since passage of NAFTA, the U.S. manufacturing sector has created 400,000 jobs, and exports to Canada and Mexico support 600,000 more jobs today than in 1993. (Signed 12/8/93)1994March 31Goals 2000 Education Standards EnactedThis legislation provided assistance to states to implement high standards and challenging curricula to help all children succeed. Today, 49 states require students to meet tough standards in core subjects, and 48 states test reading and mathematics skills in elementary, middle and high school to ensure students are meeting those standards. (PL 103-227, signed 3/31/94)May 18Head Start Reform and Creation of Early Head StartPresident Clinton and Vice President Gore advocated for legislation increasing Head Start participation and quality. The new bill established minimum performance standards, strong accountability and created the Early Head Start program for children aged 0 to 3. The Administration has increased funding for Head Start by more than 90 percent since 1993. Head Start and Early Head Start will reach approximately 935,000 in 2001. (PL 103-252, signed 5/18/94)September 13Crime Bill SignedEnacted the Clinton-Gore Administration's tough and smart crime fighting strategy. The Bill contained tougher penalties, including "three strikes and you're out" legislation, helped states build more prisons and increased prevention and victims rights. As a result, the overall crime rate has dropped for 8 years in a row — the longest continuous drop on record — and is now at a 26 year low. (PL 103-322, signed 9/13/94)Assault Weapons BanPresident Clinton and Vice President Gore overcame intense opposition by the gun lobby to ban 19 of the most dangerous assault weapons. Thanks in part to the Clinton-Gore Administration's efforts to take these dangerous guns off the streets, overall gun violence has declined by 40 percent since 1992. (PL 103-322, signed 9/13/94)100,000 Community Police OfficersThe Clinton-Gore Administration succeeded in passing a bill authorizing local governments funding to hire and redeploy 100,000 community police officers. COPS helped contribute to a decline that brought the overall crime rate to the lowest level in 26 years. In 1999, crime fell for the eighth consecutive year nationwide. (PL 103-322, signed 9/13/94)Violence Against Women ActThe Clinton-Gore Administration fought for and signed this bill, which contains new penalties, resources to prosecute more domestic violence offenders, and quadrupled funding for battered women's shelters. The Administration also established a nationwide 24-hour Domestic Violence Hotline. This initiative represents the first federal effort to address domestic violence and violence against women. Today, the number of victims of domestic violence has fallen from 1.1 million in 1993 to 876,340 in 1998. (PL 103-322, signed 9/13/94)September 23Community Development Financial Institutions (CDFI) Fund CreatedMeeting an early campaign commitment, the President signed legislation creating the CDFI Fund to support both specialized financial institutions and traditional banks that serve lower-income communities. As of late 2000, the CDFI Fund had certified over 400 community development banks, community development credit unions, housing and business loan funds and venture capital firms as CDFIs. The CDFI Fund has provided over $427 million in funding to institutions that provide capital and financial services to underserved markets.October 20Improving America's Schools ActThis reauthorization of the 1965 Elementary and Secondary Education Act ended the era of lower expectations for disadvantaged children by insisting that all students be held to the same high academic standards. The bill also strengthened accountability for student performance and required states to turn around low-performing schools.October 31California Desert Protection Act SignedThe largest land protection bill since 1980 protected nearly 8 million acres of wilderness and created three new national parks. (PL 103-433, signed 10/31/94)December 8GATT RatifiedThe Clinton-Gore Administration worked with a bipartisan majority in the Senate to pass legislation implementing the General Agreement on Tariffs and trade (GATT). This agreement allows American workers and businesses to compete in a freer, fairer, and more effective global trading system. (PL 103-465, signed 12/8/94)1995January 25Called for National Campaign to Prevent Teen PregnancyIn his State of the Union address, the President challenged Americans to join together in a national campaign against teen pregnancy. Both teen birth rates and teen pregnancy rates are now at the lowest level on record.January 31Loans Preventing Economic Collapse in Mexico IssuedAfter Congress refused to act, President Clinton issued $20 billion in emergency loans to Mexico to stabilize the country's financial markets. Loans from the United States and the International Monetary Fund stopped the collapse of the peso, prevented economic crisis, and helped the country return to solid economic growth. Mexico repaid the loans with interest three years ahead of schedule. U.S. taxpayers made a net gain of nearly $580 million from the loan.February 27Federal Child Support Enforcement ExpandedThe President issued an executive order stepping up federal efforts to collect child support payments. The Clinton Administration's strategy of encouraging parental responsibility and increasing child support enforcement efforts has doubled collections of child support from $8 billion in 1992 to $16 billion in 1999. (Exec. Order 12953)March 8Executive Order Preventing Permanent Striker Replacement IssuedIn order to maintain fairness and balance between workers and management, President Clinton issued an executive order preventing the federal government from contracting with businesses that hire permanent replacements for employees engaging in lawful strikes. (Exec. Order 12954)July 12Religious Freedom in Schools ProtectedIn order to protect religious expression in public schools while preserving the separation of church and state, President Clinton issued an executive memorandum outlining several principles of religious expression in schools. This directive clarified that under our Constitution students are free to express their religious views, pray and discuss religion at school in a non-disruptive and non-coercive manner and that teachers may teach about the importance of religion in art, literature and history. At the same time, schools and teachers may not endorse religious activity or doctrine, nor may they coerce participation in religious activity. (Exec. Memorandum 7/12/95)August 10First-Ever Comprehensive Plan to Reduce Youth Smoking ProposedThe Clinton-Gore Administration proposed the first-ever comprehensive plan to reduce youth smoking. The proposal required young people to prove their age to buy cigarettes, banned vending machines in places where minors can go, ended the marketing of cigarettes and tobacco to minors, and required the tobacco industry to fund an education campaign to prevent kids from smoking. The proposal took effect when new FDA regulations were announced on August 23, 1996.December 14Dayton Peace Accords SignedLeaders of the rival factions in the Bosnian civil war signed a treaty to end the nearly four-year-old conflict, formally approving the pact they had initialed in November in Dayton, Ohio after three weeks of U.S.-sponsored talks.1996January 23National Campaign to Prevent Teen PregnancyThe National Campaign to Prevent Teen Pregnancy was formed in response to the President's 1995 State of the Union. Since President Clinton took office, teen birth rates have dropped 18 percent, to the lowest level on record.February 8Telecommunications Reform SignedPresident Clinton and Vice President Gore achieved the first major overhaul of the telecommunications laws in 60 years. Reforms of the 1934 Telecommunications Act opened up competition between local telephone companies, long distance providers and cable companies; and required the use of new V-chip technology to enable families to exercise greater control over the television programming that comes into their homes. The Act also contained the Vice President's E-Rate proposal, which provides low-cost Internet connections for schools, libraries, rural health clinics and hospitals. (PL 104-104, signed 2/8/96)February 24Encouraged the Adoption of School UniformsPresident Clinton took steps to offer support and make it easier for schools to voluntarily adopt school uniform policies. Schools across the nation have demonstrated that school uniforms can lead to safer schools, more disciplined and orderly classrooms, and free teachers to focus on teaching and students to focus on learning.April 24Antiterrorism LawThe President signed the Antiterrorism and Effective Death Penalty Act into law at a ceremony at the White House. President Clinton first sent this legislation to Congress in February 1995 and called for additional antiterrorism measures and actions after the devastation of the federal building in Oklahoma City. The 1996 law included measures to combat terrorism at home and abroad including provisions to provide broad Federal jurisdiction to prosecute terrorist acts, bar terrorists from entering the United States in the first place, toughen penalties over a range of terrorist crimes and increase controls over biological and chemical weapons.May 17Megan's LawThe President signed Megan's law to require states to notify communities when a dangerous sexual predator resides or moves to the community. The passage of Megan's Law built on provisions contained in the 1994 Crime Bill, the Jacob Wetterling Crimes Against Children and Sexually Violent Offender Registration Act, which promoted the establishment of state sex offender registration systems for child molesters and other sexually violent offenders.July 16Moving Welfare Recipients to WorkPresident Clinton took the first national steps to require welfare recipients to move to work. An executive memorandum issued by the President required participants in federal training programs for welfare recipients to work to agree to go to work within two years or face the prospect of losing their federal assistance. (Exec. Memorandum 7/16/96)August 3Food Quality Protection Act SignedThis Act established the toughest standards for pesticide residues in food ever, and for the first times required that the standards take into account special risks to children. (PL 104-170, signed 8/3/96)August 6Safe Drinking Water ActAmendments to the Safe Drinking Water Act required the strongest standards of safety and purity in America's drinking water while establishing a revolving loan fund to help communities upgrade their water treatment facilities. (PL 104-182, signed 8/6/96)August 20Minimum Wage IncreasedPresident Clinton and Vice President Gore fought for and won a 90-cent per hour increase in the minimum wage — increasing wages for 10 million workers. This increase was the first in 6 years and in 1996 it was the largest single-year increase ever. (PL 104-134, signed 8/20/96)August 21Kennedy-Kassebaum Health Insurance Reform (Health Insurance Portability and Accountability Act)This bipartisan health insurance reform bill prevents individuals from being denied coverage because they have a preexisting medical condition. It requires insurance companies to sell coverage to small employer groups and to individuals who lose group coverage without regard to their health risk status. It also prohibits discrimination in enrollment and premiums against employees and their dependents based on health status. Finally, it requires insurers to renew the policies they sell to groups and individuals. As many as 25 million people have benefited from the greater flexibility that this law ensures. (PL 104-191, signed 8/21/96)Requiring Mental Health Parity for Annual and Lifetime Insurance LimitsTo help eliminate discrimination against individuals with mental illnesses, the President enacted legislation containing provisions prohibiting health plans from establishing separate lifetime and annual limits for mental health coverage.New Protections for Mothers and NewbornsThe President signed into law common sense legislation that requires health plans to allow new mothers to remain in the hospital for at least 48 hours following most normal deliveries and 96 hours after a Cesarean section.Eliminating the Discriminatory Tax Treatment of the Self- EmployedHIPAA increased the tax deduction from 30 percent to 80 percent for the approximately 10 million Americans who are self-employed. The President also signed into law a provision to phase it in to 100 percent in the Balanced Budget Act of 1997.Fighting Fraud and Waste in MedicareThe Kennedy-Kassenbaum legislation created a new stable source of funding to fight fraud and abuse that is coordinated by the HHS Office of the Inspector General and the Department of Justice. Since its passage, nearly $1.6 billion in fraud and abuse savings has been returned to the Medicare Trust Fund. Since 1993, the Clinton Administration has assigned more federal prosecutors and FBI agents to fight health care fraud than ever before. As a result, convictions have gone up a full 410 percent saving more than $50 billion in health care claims.August 22Welfare Reform EnactedPresident Clinton kept his promise to end welfare as we know it by requiring welfare recipients to work, limiting the time they can stay on welfare, and providing child care and health care to help them make the move from welfare to work. The landmark bipartisan welfare reform law signed by the President also enacted tough new child support enforcement measures proposed by the President. Since January 1993, the number of people on welfare has fallen by nearly 60 percent, from 14.1 million to 5.8 million, the smallest welfare rolls in 32 years, and millions of parents have joined the workforce. (PL 104-193, signed 8/22/96)September 5Designated Commission to Design Patients' Bill of RightsPresident Clinton created the National Commission on Health Care Quality and charged it with studying the need for consumer protections and ways to guarantee the quality of care. Commission members represented government, consumers, health care providers, insurers, and businesses. The recommendations of the Commission formed the basis for the Patients' Bill of Rights. (Exec. Order 13017)September 18Created Grand Staircase-Escalante National MonumentThe creation of this National Monument preserved unspoiled remote canyons and extensive geologic and world-class paleontological sites. President Clinton was the first President to designate a National Monument since 1978 and throughout his term the President has protected more land as national monuments in the lower 48 states — over 4.6 million acres — than any president in history. (Presidential Proclamation, 9/18/96)1997February 19Launched Youth Anti-Drug Media CampaignThe President unveiled his National Drug Control Strategy that set forth a long-term national effort to reduce illicit drug use and its consequences. Highlights of the Strategy included: a new $175 million national media campaign targeting illegal drug use by youth; 500 additional border patrol agents to stem the flow of illegal drugs across the Southwest Border; and $40 million for counter-drug programs in Peru — the primary cocaine source country.March 4Banned Federal Research on Human CloningBecause of the profound ethical issues raised by advances in cloning technology, the President issued a memorandum prohibiting the use of federal funds to clone human beings and urged the entire scientific and medical community to adopt a voluntary moratorium on the cloning of human beings. (Exec. Memorandum, 3/4/97)April 24Chemical Weapons Convention RatifiedThe Senate ratified the Chemical Weapons Convention, which makes the production, acquisition, stockpiling, transfer and use of chemical weapons illegal. (Ratified 4/24/97)May 20Created the Welfare to Work PartnershipThe Welfare to Work Partnership was launched at the President's urging to lead the national business effort to hire people from the welfare rolls. Now 20,000 businesses strong, the Partnership has helped an estimated 1.1 million welfare recipients move to employment. Under Vice President Gore's leadership, the Administration has also done its fair share, hiring 50,000 welfare recipients, and has fostered partnerships between employers and community and faith-based organizations that help families move from welfare to work.June 4Individuals With Disabilities Education Act ReauthorizedThe expanded IDEA applies the same high academic standards for all children, ensuring that children with disabilities learn the same things with the same curricula and the same assessments as all other children. It also ensures that more children with disabilities can be in regular classrooms and take part in all school functions including field trips and extracurricular activities. (Signed 6/4/97)June 12Established the Initiative for One AmericaTo help facilitate a national dialogue aimed at narrowing America's racial divide, the President appointed a seven-member Advisory Board on Race. Over the next 15 months, Board members, individually and in teams, held hundreds of meetings involving thousands of people in every region of the country. They submitted several policy proposals that have guided the Administration in its effort to close the racial gaps that still exist in America. These include increased civil rights enforcement, increased early childhood education and undertaking efforts to make sure all Americans benefit from our country's prosperity. The work of the Advisory Board also led to the creation of the One America Office in the White House to promote the President's goals of educating the American public about race, encourage racial reconciliation through national dialogue on race, identify policies that can expand opportunities for racial and ethnic minorities, and coordinate the work of the White House and federal agencies to carry out the President's vision of One America.July 16Stronger Air Quality Regulations ReleasedThe President approved the strongest air quality standards in history to control pollution from smog and soot. The standards could prevent 15,000 premature deaths every year and will improve the lives of millions of Americans suffering from respiratory illness. Enforcement of the new standards has been delayed by court action. (7/16/97)August 5Balanced Budget Agreement ReachedIn February, the President submitted the first plan to finish the job of eliminating the deficit and the balanced budget in 27 years. On August 5th, he signed the Balanced Budget Act of 1997, which finished the job of eliminating the $290 billion budget deficit. (PL 105-34, signed 8/5/97)$500 per Child Tax CreditAs part of the Balanced Budget Agreement, the President secured a $500 per child tax credit for approximately 27 million families with children under 17, including thirteen million children from families with incomes below $30,000. (PL 105-34, signed 8/5/97)Children's Health Insurance Program CreatedAt the urging of the Clinton-Gore Administration, Congress invested $48 billion for the State Children's Health Insurance Program — the single largest investment in health care for children since the enactment of Medicaid in 1965. This new program, together with Medicaid, will provide meaningful health care coverage for up to five million previously uninsured children — including prescription drugs, vision, hearing, and mental health services. Within three years of enactment, all 50 states have implemented S-CHIP programs, and over 2 million children have been covered. In addition, the number of states covering children up to 200 percent of poverty increased by more than sevenfold — to 30 states — during that time. (PL 105-34, signed 8/5/97)Strengthening the Medicare Trust FundWhen the President came into office, Medicare was projected to become insolvent in 1999. The Balanced Budget Act extended the life of the Trust Fund by an additional 10 years resulting in the longest Medicare Trust Fund solvency in a quarter century, extending the life of the Medicare Trust Fund by a total of 26 years and offering premiums that are nearly 20 percent lower today than projected in 1993.Modernizing the Medicare Benefit PackageThe BBA included a series of structural reforms which modernize the program, bringing it in line with the private sector and preparing it for the baby boom generation. These reforms: waived cost-sharing for mammography services and provided annual screening mammograms for beneficiaries age 40 and older to help detect breast cancer; established a diabetes self-management benefit; ensured Medicare coverage of colorectal screening and cervical cancer screening; ensured coverage of bone mass measurement tests to help women detect osteoporosis, and increased reimbursement rates for certain immunizations to protect seniors from pneumonia, influenza, and hepatitis.HOPE Scholarships/Lifetime Learning Tax CreditsPresident Clinton proposed and passed the largest increase in college opportunity since the GI bill. The HOPE Scholarship provides a tax credit of up to $1,500 for tuition and fees for the first two years of college. When fully phased-in, the Lifetime Learning tax credit will provide a 20 percent tax credit on the first $10,000 of tuition and fees for students beyond the first two years of college, or taking classes part-time. (PL 105-34, signed 8/5/97)Welfare-to-Work GrantsDue to President Clinton's leadership, the Balanced Budget Act included $3 billion over two years for Welfare-to-Work grants to help states and local communities move long-term welfare recipients and certain non-custodial parent in lasting, unsubsidized jobs. This funding, used for job creation, placement and retention efforts, has helped the hardest-to-serve welfare recipients and promotes parental responsibility among non-custodial parents who need to find work to honor their responsibilities to their children.Landmark Education Investments: America Reads, Charter Schools, Education TechnologyThe President succeeded in doubling investments in education technology, increasing charter school funding, expanding Head Start to reach more than 800,000 children, and increasing the maximum Pell Grant by 63 percent, to the largest maximum award ever. The Budget also provided $300 million for the President's America Reads Challenge. Together, these programs are the most significant increase in education funding at the national level in 30 years. (PL 105-34, signed 8/5/97)Created 20 more Empowerment Zones and 20 more rural Enterprise CommunitiesFollowing Congress' 1994 designation of Cleveland and Los Angeles as EZs, the President requested a Round 2 of 20 new EZs and 20 new rural Enterprise Communities. The Round 2 EZs received expanded tax-exempt bonding authority to increase their ability to stimulate private-sector job creation for low-income residents.August 9Created Smoke-Free Federal WorkplacesPresident Clinton issued an Executive Order protecting Federal Government employees and members of the public from exposure to tobacco smoke in the Federal workplace and encouraged Federal agencies to establish programs to help employees stop smoking. The Clinton-Gore Administration has also made our nation's health a priority by developing the first-ever plan to protect our children from tobacco, raising the federal tobacco tax, and by giving the American people their day in court against the tobacco manufacturers who engaged in decades of deception about the dangers of tobacco.August 13Required Drug Companies Provide Adequate Testing for ChildrenPresident Clinton directed an important Food and Drug Administration regulation requiring manufacturers to do studies on pediatric populations for new prescription drugs — and those currently on the market — to ensure that prescription drugs have been adequately tested for the unique needs of children.August 27America Reads Child Literacy Initiative LaunchedThe President set a national goal of making sure that every child can read independently by the end of third grade. To reach this goal, the President issued the America Reads challenge, calling for one million tutors — college, university students, senior citizens, and private sector employees — to help children learn to read. In 1997, Congress funded the initiative, with $300 million in grants to help states improve children's reading skills. More than two million children have been tutored to read by national service programs such as AmeriCorps, VISTA, and Foster Grandparents.October 9Reached Agreement to Provide Child-Safety Locks With HandgunsThe President announced an agreement with eight of the country's largest gun manufacturers to include child safety locks with all new handguns. The voluntary agreement was reached after negotiations between the President, the gun manufacturers and the American Shooting Sports Council. The President had previously issued an Executive Memorandum requiring federal law enforcement authorities to provide child safety locks for their officers' firearms.November 19Adoption and Safe Families Act PassedThis bipartisan legislation enacted many of the recommendations of the President's Adoption 2002 report. In order to meet the President's challenge of doubling the number of adoptions by 2002, the Act provides incentives to states to permanently place children in foster care. In 1999, 46,000 foster care children were adopted — more than a 64 percent increase since 1996 and the biggest increase in adoptions since the National Foster Care Program was created almost 20 years ago. (PL 105-89, signed 11/19/97)November 20Endorsed the Recommendations of the Historic Quality Commission.In 1996, the President created a non-partisan, broad-based Commission on quality and charged them with developing a patients' bill of rights as their first order of business. In October of 1997, the President accepted the Commission's recommendation that all health plans should provide strong patient protections, including guaranteed access to needed health care specialists; access to emergency room services when and where the need arises; continuity of care protections; and access to a fair, unbiased and timely internal and independent external appeals process. The work of the Commission lay the foundation for subsequent administrative and legislative initiatives to improve patient protections and quality improvement.November 21FDA Reform Legislation SignedThe President supported and signed the FDA Modernization Act of 1997, the first major food and medical products reform in 35 years. The Act cut approval times of new drugs in half, simplified the review process for medical devices, expanded participation in experimental treatments for AIDS, Alzheimer's and cancer patients, and protected consumers by ensuring accurate food labeling. (PL 105-115, signed 11/21/97)December 16NATO Expanded to Eastern EuropeSecretary of State Madeleine Albright signed protocols for the accession of Poland, Hungary and the Czech Republic into NATO. The expansion of NATO to include these three former Warsaw Pact nations was a historic step in ensuring peace and stability in Eastern Europe. NATO expansion was ratified in May 1998 after it was approved by a strong bipartisan Senate majority.1998January 7Child Care InitiativeThe President successfully initiated an historic effort to improve child care for America's working families. President Clinton's initiative responded to the struggles our nation's working parents face in finding child care that they can afford, trust, and rely on. The President's initiative helped working families pay for child care by more than doubling funding for child care subsidies and nearly doubling funding for Head Start; it built a supply of good after-school programs that will serve 1.3 million children in 2001; and, it is working to improve the safety and quality of care, and promote early learning through the recently passed Early Learning Opportunities Act.February 20Implemented the Patients' Bill of Rights for Federal Health PlansIn order to ensure that 85 million Americans in federal health plans benefit from essential health protections developed by the President's Health Care Quality Commission, President Clinton ordered federal health plans to comply with provisions of the Patients' Bill of Rights. The President's order guaranteed choice of providers and plans, access to emergency services, participation in treatment decisions, confidentiality of health information and a fair complaint and appeals process. Medicare, Medicaid, S-CHIP, the Indian Health Service, FEHBP plans, the Veterans Administration facilities, and the Military Health System are responding by ensuring that all protections that can be extended under current law be provided.April 11Good Friday Peace Accords SignedPresident Clinton helped conclude the Good Friday Peace Accords, a historic peace agreement between all the major parties to the long conflict over Northern Ireland. The accord represents the best hope in a generation for a just and lasting peace in Northern Ireland. (4/11/98)July 16Child Support IncentivesThe President signed into law the "Child Support Performance and Incentive Act of 1998," which built on prior legislative and executive actions to improve child support collections by establishing performance-based rewards for states on a range of key child support goals. The Clinton Administration has taken great strides in promoting responsible fatherhood; since 1992, paternity establishment has tripled and child support collections have doubled.July 21Improving Nursing Home QualityIn July of 1998, President Clinton initiated a new nursing home quality initiative that ensures swift and strong penalties for nursing homes failing to comply with standards, strengthened oversight of state enforcement mechanisms, and implemented unprecedented efforts to improve nutrition and prevent bed sores. Finally, the Administration recently instructed states to eliminate corrective periods during which nursing homes could avoid the imposition of sanctions, such as fines, when a nursing home is found to have caused harm to a resident on consecutive surveys, in order to put additional pressure on nursing homes to meet all health and safety standards.August 7Workforce Investment ActLong championed by President Clinton and Vice-President Gore, this bi-partisan legislation was enacted to streamline and bring greater accountability to our nation's job training system. (signed 8/7/98)October 7GEAR UP Initiative CreatedIn his 1998 State of the Union address, President Clinton urged Congress "to support our efforts to enlist colleges and universities to reach out to disadvantaged children, starting in the 7th grade, so that they can get the guidance and hope they need so they can know that they, too, will be able to go on to college." Congress enacted GEAR UP without a single dissenting vote. GEAR UP provides intensive early intervention services that have helped prepare up to 700,000 students at high-poverty middle schools for college. GEAR UP was included in the Higher Education Amendments of 1998, which also reduced student loan interest rates, saving students about $50 for every $1,000 in debt; supported partnerships between universities and school systems to strengthen teacher preparation and quality; and created the first federal performance-based organization to administer student aid. (signed 10/7/98)October 21Class Size Reduction Initiative LaunchedAfter initially refusing to provide any funding at all, Congress agreed to provide $1.2 billion for the first year of the President's new initiative to hire 100,000 new teachers to reduce class size in the early grades to a national average of 18. This initiative is the first comprehensive effort to reduce class size across the nation. (PL 105-277, signed 10/21/98)21st Century Community Learning CentersIn 1998, a Clinton Administration initiative launched a series of dramatic funding increases for before- and after-school programs, turning a small demonstration program into one of the most popular Federal education programs. President Clinton won $846 million for the 21st Century Community Learning Centers program for 2001, up from only $1 million in 1997, and it will serve about 1.3 million children.October 23Wye Middle East Peace Agreement SignedAfter nine days of negotiations at the Wye Conference Center in Maryland, Israeli Prime Minister Benjamin Netanyahu and Palestinian Authority President Yasser Arafat signed an agreement that will strengthen Israeli security, expand the area of Palestinian control in the West Bank, and enhance opportunities for the Israeli and Palestinian people. (10/23/98)October 27Head Start Expansion and Reauthorization (Human Services Reauthorization Act)The reauthorization of Head Start paved the way for further quality improvements, doubled participation in the Early Head Start program and moved toward the President's goal of providing quality Head Start opportunities for one million children. (PL 105-285, 10/27/98)Individual Development AccountsIn addition to reauthorizing Head Start, the Human Services Reauthorization Act of 1998 also created the Individual Development Account Demonstration Program to encourage low-income families to save for a first home, post-secondary education or to start a new business. (PL 105-285, 10/27/98)December 12Global Warming Protocol Signed in Kyoto, JapanWith critical leadership from the Clinton-Gore Administration, 160 nations agreed on the basic architecture of a strategy to combat global warming on December 12, 1997. This agreement is the first time that major nations of the world ever committed themselves to a comprehensive plan to cut greenhouse gas emissions.December 16Air Attacks on Saddam HusseinBeginning December 16, 1998, American forces attacked Iraq's nuclear, chemical, and biological programs, and its military capacity to threaten its neighbors. Saddam Hussein had announced that he would no longer cooperate with UN inspectors to conduct inspections that would guarantee that Iraq does not try and rebuild its capacity to create weapons of mass destruction.1999April 29Education Flexibility Partnership Act of 1999 SignedEd-Flex is designed to help districts and schools carry out educational reforms and raise the achievement levels of all children by providing increased flexibility in the implementation of federal education programs. In exchange, states are required to demonstrate enhanced accountability for the performance of all students.March 12Clarifying Over The Counter Drug LabelsThe President unveiled a historic new FDA regulation that, for the first time, requires over-the-counter drug products to use a new product label with larger print and clearer language, making it easier for consumers to understand product warnings and comply with dosage guidance. The new regulation provides Americans with essential information about their medications in a user friendly way and takes a critical first step towards preventing the tens of thousands of unnecessary hospitalizations caused by misuse of over-the-counter medications each year.April 27Education Flexibility Partnership Act SignedThis legislation expanded the Ed-Flex demonstration program to enable all states, the District of Columbia, Puerto Rico, and the territories to form Ed-Flex partnerships, giving states and communities the ability to use federal resources in the ways that best complement local efforts and innovation. Under Ed-Flex, states can waive many of the requirements of federal education programs in exchange for accountability for results.May 12100,000 Officers FundedUnder budget and ahead of schedule, the President's goal of funding 100,000 officers was reached. The President's successful community policing initiative has played a key role in producing the longest continuous drop in crime on record. In November 1999, President Clinton secured funding for the first installment of his 21st Century Policing Initiative over Congressional opposition. The new initiative will fund up to 50,000 additional community police officers by 2005 and equip them with new, advanced tools to fight crime. (PL 106-113, signed 11/29/99)June 16Leading the World in Eliminating Child LaborIn June 1999, the President traveled to the International Labor Organization Conference in Geneva, Switzerland to urge adoption of an historic international convention that would ban the worst forms of child labor. The next day, the Child Labor Convention was unanimously adopted by delegates at the conference. It represents the largest investment in American history to end abusive child labor around the globe.June 20Achieving Victory in KosovoPresident Clinton led the NATO Alliance in a 79-day air war that expelled Serb forces from Kosovo and restored self-government to the province, ending a decade of repression and reversing Slobodan Milosevic's brutal campaign of ethnic cleansing. In the face of Allied unity, American military superiority, and strong Presidential leadership, Milosevic withdrew his troops and permitted international peacekeepers to begin returning refugees. (3/24-6/20/99)October 29Medical Privacy Protections AnnouncedPresident Clinton announced new regulations to protect the privacy of personal medical records. The President's action gave consumers greater access to and control over their records, restricted the disclosure of protected health information to the minimum necessary, and established new disclosure requirements for researchers and others seeking access to health records.November 12Financial Modernization Legislation EnactedPresident Clinton signed the Financial Modernization Act into law, finally revamping a banking system that had been in place since the Great Depression. The new law will increase innovation and competition in the financial services industry, including traditional banking, insurance and securities industries, giving consumers greater choice and lower prices. The President insisted that the new regulatory structure permit banking institutions to expand into these newly authorized lines of business only if they satisfactorily serve the credit needs of their communities, and that the law include many of the consumer privacy provisions he proposed. (PL 106-102, signed 11/12/99)November 18Expanded Federal Investment in After-School and Summer School ProgramsPresident Clinton signed a significant increase in 21st Century Community Learning Centers, expanding the federal investment in after-school and summer school programs from a small pilot project. This initiative currently serves over 850,000 Americans nationwide, and will serve 1.3 million children next year.November 29Work Incentives Improvement Act SignedAfter months of congressional inaction, President Clinton insisted that Congress pass the Work Incentives Improvement Act as a condition of the budget agreement. This bipartisan Act allows people with disabilities to maintain their Medicare or Medicaid coverage when they go to work. This law represents one of the most important legislative advances for people with disabilities since the enactment of the Americans with Disabilities Act. (PL 106-113, signed 11/29/99)Leveraged $90 Billion in International Debt ReliefPresident Clinton has been an international leader in recognizing and solving the debt problems of developing countries. To meet the commitments he made at the G-7 Economic Summit in Cologne in June and at his address to the IMF and World Bank Annual Meetings in September, President Clinton secured funds from Congress to leverage over $90 billion of debt relief for developing nations. Along with funds from other creditor nations, this plan tripled the amount of debt relief available to the world's poorest nations. (PL 106-113, signed 11/29/99)December 14Enacted New Legislation to Help Young People Leaving Foster CareToday, when young people emancipate from foster care, they face numerous health risks, but too often lose their health insurance. The new law grants states the option for these young people to remain eligible for Medicaid up to age 21. HHS issued guidance to all State Medicaid Directors encouraging them to take up this option. (Public Law 106-169)2000March 17Historic Smith & Wesson AgreementThe President announced the Administration's historic Agreement with several cities and counties and the nation's largest handgun manufacturer, Smith & Wesson, to reform the way they design, distribute and market their products. Among the key provisions are new design standards to make guns safer and prevent accidental shootings and gun deaths, such as locking devices on handguns and the incorporation of smart gun technology, and sales and distribution controls to help keep guns out of the hands of criminals and to crack down on illegal gun traffickers, such as cutting off dealers that sell a disproportionate share of crime guns and not selling to dealers who sell at gun shows unless background checks are conducted.April 7Senior Citizen's Freedom to Work Act PassedIn his January 1999 State of the Union Address the President stated that "we should eliminate the limits on what seniors on Social Security can earn." In 2000, the House and Senate unanimously voted to eliminate the retirement earnings test for people above the normal retirement age. (PL 106-182, signed 4/7/00)April 15Created New National Monument To Preserve Ancient SequoiasPresident Clinton signed a proclamation creating the Giant Sequoia National Monument. This 328,000-acre monument will ensure lasting protection for 34 groves of ancient sequoias, the largest trees on Earth. (4/15/00)May 18Africa Growth and Opportunity Act and the U.S.-Caribbean Basin Trade Partnership Act SignedExpands two-way trade and create incentives for the countries of sub-Saharan Africa (SSA) and the Caribbean Basin to continue reforming their economies and participate more fully in the benefits of the global economy. This area forms the sixth largest export market for the United States. (PL 106-200, signed 5/18/00)June 7Providing Medicare Reimbursement For Costs Associated with Participation in Clinical TrialsThe President issued an Executive Memorandum directing the Medicare program to revise its payment policy and immediately begin to explicitly reimburse providers for the cost of routine patient care associated with participation in clinical trials. HHS was directed to take additional action to promote the participation of Medicare beneficiaries in clinical trials for all diseases, including activities to increase beneficiary awareness of the new coverage option and actions to ensure that the information gained from important clinical trials is used to inform coverage decisions by properly structuring the trial.June 9Preserved Four Unique and Irreplaceable National MonumentsPresident Clinton signed proclamations creating four new national monuments to protect federal lands representing unique, irreplaceable pieces of America's natural and cultural heritage. The four are the Canyons of the Ancients National Monument in southwest Colorado, the Cascade-Siskiyou National Monument in southern Oregon, the Hanford Reach National Monument in south central Washington, and the Ironwood Forest National Monument in southern Arizona.June 30Electronic Signatures in Global and National Commerce Act SignedThis Act eliminated legal barriers to using electronic technology to form and sign contracts, collect and store documents, and send and receive notices and disclosures. It also contained important protections making sure that consumers shopping on-line are protected to the same extent as paper transactions. (PL 106-229, signed 6/30/00)July 1Campaign Finance Disclosure EnactedPresident Clinton signed the first new campaign finance reform legislation in 20 years, closing a loophole that allowed tax-exempt groups to use undisclosed donors to pay for political ad campaigns. (PL 106-230, signed 7/1/00)July 13Plan Colombia EnactedPresident Clinton proposed a new aid package to bolster democracy and combat drug trafficking in Colombia. The agreement will enhance alternative development, strengthen civil justice and democratic institutions, and provide assistance aimed at reducing the flow of cocaine and other narcotics to the United States. (PL 106-246, signed 7/13/00)October 10China-PNTR EnactedThis Act was a crucial step to complete a major trade goal of the Clinton-Gore Administration, opening China's markets to American manufactured goods, farm products and services by allowing China to become part of the WTO, forcing it to slash import barriers against American goods and services. The United States agreed to maintain market access policies we currently apply to China. (PL 106-286, signed 10/10/00)October 24Providing Health Insurance to Women With Breast CancerPresident Clinton enacted legislation to provide a new Medicaid option to provide needed insurance coverage to the thousands of uninsured women with breast and cervical cancer detected by Federally supported screening programs. This new proposal will help eliminate the current and frequently overwhelming financial barriers to treatment for these women.October 27Victims of Trafficking and Violence Prevention Act of 2000The President signed this landmark legislation, which expands and strengthens the Violence Against Women Act, passed as part of the Crime Bill in 1994. The legislation also provides new tools and resources to combat the worldwide scourge of trafficking in persons and helps American victims of terrorism abroad to collect court-awarded compensation. From 1993 through 1998, violence against women by intimate partners fell by 21 percent. (PL 106-386, 10/27/00)Reauthorizing the Older Americans ActThe Older Americans Act ensures that millions of seniors nationwide have access to meals, nursing home ombudsmen, legal assistance, elder abuse prevention, employment and transportation services that are essential to their dignity and independence. This legislation includes the National Family Caregiver Support Program — a key Administration priority designed to provide respite care and other supportive services to help hundreds of thousands of families who are struggling to care for their older loved ones who are ill or disabled.November 13New Worker Health And Safety Rules To Prevent Repetitive Stress Injuries AnnouncedThe new rule announced by the Administration is aimed at reducing approximately 1.8 million repetitive stress injuries that affect workers. Based on extensive scientific research and public comment, the Administration's proposal would save 300,000 workers the pain and suffering associated with these injuries, and save American businesses $9 billion a year in workers compensation and lost productivity. The final rules will take effect January 16, 2001.December 15Passed $1.2 Billion for Emergency School RepairsIn the FY 2001 budget, President Clinton won passage of an historic $1.2 billion initiative for emergency school renovation. The initiative will help schools make much-needed repairs, such as roofs, heating and cooling systems, and electrical wiring. The assistance would be targeted to high-need districts and includes $75 million for public schools with high concentrations of Native American students.Passed the New Markets InitiativeThe FY 2001 budget also includes historic bipartisan New Markets and community renewal initiative -- the most significant effort ever to help hard-pressed communities lift themselves up through private investment and entrepreneurship. With the help of the New Markets tax credit, 40 strengthened empowerment zones and 40 renewal communities, this initiative will spur billions of dollars in private investment, and ensure that every American will share in nation's economic prosperity.Budget Includes Important Investments in Health CareThe President's longstanding commitment to expand access to quality health care for all Americans is reflected in the FY 2001 budget, which includes a multi-billion dollar effort to provide low-income children, seniors and people with disabilities, and those leaving welfare for work, with health care coverage. It also expands preventive benefits like cancer and glaucoma screenings for Medicare beneficiaries.

HelloThe U.S. health care system is unique among advanced industrialized countries. The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating healthcare coverage for almost everyone. Rather than operating a national health service, a single-payer national health insurance system, or a multi-payer universal health insurance fund, the U.S. health care system can best be described as a hybrid system. In 2014, 48 percent of U.S. health care spending came from private funds, with 28 percent coming from households and 20 percent coming from private businesses. The federal government accounted for 28 percent of spending while state and local governments accounted for 17 percent.[1] Most health care, even if publicly financed, is delivered privately.In 2014, 283.2 million people in the U.S., 89.6 percent of the U.S. population had some type of health insurance, with 66 percent of workers covered by a private health insurance plan. Among the insured, 115.4 million people, 36.5 percent of the population, received coverage through the U.S. government in 2014 through Medicare (50.5 million), Medicaid (61.65 million), and/or Veterans Administration or other military care (14.14 million) (people may be covered by more than one government plan). In 2014, nearly 32.9 million people in the U.S. had no health insurance.[2]This fact sheet will compare the U.S. health care system to other advanced industrialized nations, with a focus on the problems of high health care costs and disparities in insurance coverage in the U.S. It will then outline some common methods used in other countries to lower health care costs, examine the German health care system as a model for non-centralized universal care, and put the quality of U.S. health care in an international context.In Comparison to Other OECD CountriesThe Organization for Economic Co-operation and Development (OECD) is an international forum committed to global development that brings together 34 member countries to compare and discuss government policy in order to “promote policies that will improve the economic and social well-being of people around the world.”[3] The OECD countries are generally advanced or emerging economies. Of the member states, the U.S. and Mexican governments play the smallest role in overall financing of health care.[4] However, public (i.e. government) spending on health care per capita in the U.S. is greater than all other OECD countries, except Norway and the Netherlands.[5]This seeming anomaly is attributable, in part, to the high cost of health care in the U.S. Indeed, the U.S. spends considerably more on health care than any other OECD country.The OECD found that in 2013, the U.S. spent $8,713 per person or 16.4 percent of its GDP on health care—far higher than the OECD average of 8.9 percent per person.[6] Following the U.S. were the Netherlands, which allocated 11.1 percent of its GDP, then Switzerland also at 11.1 percent, and Sweden, which allocated 11 percent of its GDP to health care in 2013. In North America, Canada and Mexico spent respectively 10.2 percent and 6.2 percent of their GDP on health care.On a per capita basis, the U.S. spends more than double the $3,453 average of all OECD countries (see chart[7] below).[8]Health Expenditure per capita, 2013 (or nearest year)Drivers of Health Care Spending in the U.S.Prohibitively high cost is the primary reason Americans give for problems accessing health care. Americans with below-average incomes are much more likely than their counterparts in other countries to report not: visiting a physician when sick; getting a recommended test, treatment, or follow-up care; filling a prescription; and seeing a dentist.[9] Fifty-nine percent of physicians in the U.S. acknowledge their patients have difficulty paying for care.[10] In 2013, 31 percent of uninsured adults reported not getting or delaying medical care because of cost, compared to five percent of privately insured adults and 27 percent of those on public insurance, including Medicaid/CHIP and Medicare.[11]While there is no agreement as to the single cause of rising U.S. health care costs, experts have identified three contributing factors. The first is the cost of new technologies and prescription drugs. Some analysts have argued “that the availability of more expensive, state-of-the-art medical technologies and drugs fuels health care spending for development costs and because they generate demand for more intense, costly services even if they are not necessarily cost-effective.”[12]In 2013, the U.S. spent $1,026 per capita on pharmaceuticals and other non-durable medical care, more than double the OECD average of $515.[13]Another explanation for increased costs is the rise of chronic diseases, including obesity. Nationally, health care costs for chronic diseases contribute huge proportions to health care costs, particularly during end of life care. “Patients with chronic illness in their last two years of life account for about 32% of total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations.”[14] The National Academy of Sciences found that among other high-income nations the U.S. has a higher rate of chronic illness and a lower overall life expectancy. Their findings suggest that this holds true even when controlling for socio-economic disparity.[15] Experts are focusing more on preventative care in an effort to improve health and reduce the financial burdens associated with chronic disease.[16] One provision of the Patient Protection and Affordable Care Act, commonly referred to as simply the Affordable Care Act (ACA), implemented in 2013, provides additional Medicaid funding for states providing low cost access to preventative care.[17]Finally, high administrative costs are a contributing factor to the inflated costs of U.S. health care. The U.S. leads all other industrialized countries in the share of national health care expenditures devoted to insurance administration. It is difficult to determine the exact differences between public and private administrative costs, in part because the definition of “administrative” varies widely. Further, the government outsources some of its administrative needs to private firms.[18] What is clear is that larger firms spend a smaller percentage of their total expenditures on administration, and nationwide estimates suggest that as much as half of the $361 billion spent annually on administrative costs is wasteful.[19] In January 2013, a national pilot program implemented under the ACA began. The aim is to improve administrative efficiency by allowing doctors and hospitals to bundle billing for an episode of care rather than the current ad hoc method.[20]Health Insurance in the U.S.: Uneven CoverageWhile the majority of U.S. citizens have health insurance, premiums are rising and the quality of the insurance policies is falling. Average annual premiums for family coverage increased 11 percent between 1999 and 2005, but have since leveled off to increase five percent per year between 2005 and 2015.[21] Deductibles are rising even faster. Between 2010 and 2015, single coverage deductibles have risen 67 percent.[22] These figures outpace both inflation and workers’ earnings.The lack of health insurance coverage has a profound impact on the U.S. economy. The Center for American Progress estimated in 2009 that the lack of health insurance in the U.S. cost society between $124 billion and $248 billion per year. While the low end of the estimate represents just the cost of the shorter lifespans of those without insurance, the high end represents both the cost of shortened lifespans and the loss of productivity due to the reduced health of the uninsured.[23]Health insurance coverage is uneven and often minorities and the poor are underserved. Forty million workers, nearly two out of every five, do not have access to paid sick leave. Experts suggest that the economic pressure to go to work even when sick can prolong pandemics, reduce productivity, and drive up health care costs.[24]There were 32 million uninsured Americans in 2014, nine million fewer than the year prior. Experts attribute this sharp decline in the uninsured to the full implementation of the ACA in 2014.[25] Of American adults who had health insurance in 2014, 73 percent had one or more full-time workers in the family and 12 percent had one or more part-time workers in the family.[26] Just 49 percent of American adults reported getting health insurance from an employer in 2014.[27]Coverage by employer-provided insurance varies considerably by wage level. Firms with higher proportions of low-wage workers are less likely to provide access to health insurance than those with low-proportions of low-wage workers.[28]In 2014, 11.2 percent of full-time workers were without health insurance. However, the percentage of part-time workers without insurance was 17.7 percent, a significant decrease from 24 percent in 2013, thanks in part to the Affordable Care Act. The uninsured rate among those who had not worked at least one week also decreased from 22.2 percent in 2013 to 17.3 percent in 2014.[29]Smaller firms are significantly less likely to provide health benefits to full or part-time workers. Among all small firms (3-199 workers) in 2015, only 56 percent offered health coverage, compared to 98 percent of large firms.[30]After the Affordable Care Act allowed for many young adults (19-25) to remain on their parents’ health plans, there was a statistically significant increase in the percentage of insured young people from 68.3 percent in 2009[31] to 82.9 percent in 2014.[32] Over the same period, the percentage of young people aged 26-34 with insurance increased from 70.9 percent to 81.8 percent.[33]Minorities and children are disproportionately uninsured. In 2014, 7.6 percent of non-Hispanic Whites were uninsured, 11.8 percent of Blacks were uninsured, 9.3 percent of Asians, and 19.9 percent of people of Hispanic origin were uninsured.[34] The Kaiser Family Foundation has found that about 80 percent of the uninsured are U.S. citizens.[35] Among children, six percent were uninsured in 2014.[36] These children are 10 times more likely than insured children to have unmet medical needs and are five times as likely as an insured child to go more than two years without seeing a doctor.[37]Women in the individual market often faced higher premiums than men for the same coverage. Beginning in 2014, the Affordable Care Act banned this practice, as well as denying coverage for pre-existing conditions.[38]In 2014, 19.3 percent of the population living below 100 percent of the poverty line ($23,550 a year for a family of four) was uninsured.[39] According to the Kaiser Family Foundation, 90 percent of the uninsured have family incomes within 400 percent of the federal poverty level. This makes them eligible for either subsidized coverage through tax credits or expanded Medicaid eligibility under the Affordable Care Act’s state health exchanges. [40]Rising Healthcare PremiumsHealth insurance premiums in the U.S. are rising fast. From 2005 to 2015, average annual health insurance premiums for family coverage increased 61 percent, while worker contributions to those plans increased 83 percent in the same period. This rate of increase outpaces both inflation and increases in workers’ wages.[41]In 2005, the average annual premiums for employer-sponsored health insurance were $2,713 for single coverage and $8,167 for family coverage. In 2015, premiums more than doubled to $6,251 for employer-sponsored single coverage and $17,545 for employer-sponsored family coverage.[42]A growing number of workers face a deductible of $1,000 or more for individual plans. In 2015, 46 percent (compared to 38 percent in 2013 and 22 percent in 2009) of workers were enrolled in a plan with an annual deductible of $1,000 or more. Employees at small firms are more likely than those at large firms to have a deductible greater than $1,000.[43]The Union Difference: Union workers are more likely than their nonunion counterparts to be covered by health insurance and paid sick leave. In March 2015, 95 percent of union members in the civilian workforce had access to medical care benefits, compared with only 68 percent of nonunion members. In 2015, 85 percent of union members in the civilian workforce had access to paid sick leave compared to 62 percent of nonunion workers.[44] At the median, private-sector unionized workers pay 38 percent less for family coverage than private-sector nonunionized workers, according to a 2009 study.[45]Across states, there are significant disparities in both the availability and the cost of health care coverage.In 2012, Medicare reimbursements per enrollee varied from $6,724 in Anchorage, Alaska to $13,596 in Miami, Florida.[46] Annual premiums are similarly disparate. In 2015, the average family premium in the South was $16,785 while the same coverage averaged $18,096 in the Northeast.[47]Firms in the South were less likely to provide coverage for an employee’s domestic partner than other regions. In the South, 41 percent of firms reported providing benefits for same-sex partners (compared to 51 percent in the Northeast) and 20 percent reported offering benefits to opposite-sex domestic partners (compared to 46 percent in the Northeast).[48]High Costs Drive Americans into BankruptcyUniversal coverage, in countries like the United Kingdom, Switzerland, Japan, and Germany makes the number of bankruptcies related to medical expenses negligible.[49] Conversely, a 2014 survey of bankruptcies filed between 2005 and 2013 found that medical bills are the single largest cause of consumer bankruptcy, with between 18 percent and 25 percent of cases directly prompted by medical debt.[50] Another survey found that in 2013, 56 million Americans under the age of 65 had trouble paying medical bills.[51] Another 10 million will face medical bills they are unable to pay despite having year-round insurance.[52]It has been suggested, based on the experience of Massachusetts, where medical-related bankruptcies declined sharply after the state enacted its health reform law in 2006, that the ACA may help reduce such bankruptcies in the future.[53]The Affordable Care Act: Successes and Remaining ChallengesIn March, 2010, President Obama signed the ACA into law that made hundreds of significant changes to the U.S. healthcare system between 2011 and 2014. Provisions included in the ACA are intended to expand access to healthcare coverage, increase consumer protections, emphasizes prevention and wellness, and promote evidence- based treatment and administrative efficiency in an attempt to curb rising healthcare costs.Beginning in January 2014, almost all Americans are required to have some form of health insurance from either their employer, an individual plan, or through a public program such as Medicaid or Medicare. Since the so-called “individual mandate” took effect, the total number of nonelderly uninsured adults dropped from 41 million in 2013 to 32.3 million in 2014.[54] The largest coverage gains were concentrated among low-income people, people of color, and young adults, all of whom had high uninsured rates prior to 2014.[55]A major provision of the ACA was the creation of health insurance marketplace exchanges where individuals not already covered by an employer-provided plan or a program such as Medicaid or Medicare can shop for health insurance. Individuals with incomes between 100 percent and 400 percent of the federal poverty line would be eligible for advanceable premium tax credits to subsidize the cost of insurance. States have the option to create and administer their own exchanges or allow the federal government to do so. Currently, only 14 states operate their own exchanges.[56]Designed to promote competition among providers and deliver choice transparency to consumers, the state-based exchanges appear to be doing just that. A recent analysis by the Commonwealth Fund found that the number of insurers offering health insurance coverage through the marketplaces increased from 2014 to 2015.[57] Additionally, there was generally no reported increase in average premiums for marketplace plans over that period. The analysis found only a modest increase in average premiums for the lowest cost plans from 2015 to 2016.[58]The ACA also included a major expansion of the Medicaid program, although the Supreme Court ruled in 2012 that this expansion is a state option. As of November 2015, 30 states have chosen to expand Medicaid. As of 2014, adults with incomes at or below 138 percent of the federal poverty line are now eligible for Medicaid in the states that have adopted the expansion.[59]Despite improvements to the U.S healthcare system under the ACA, a number of challenges remain. In 2014, 10.4 percent of Americans were still uninsured[60], and those with insurance still face high deductibles and premium costs. Furthermore, in the 20 states that had not expanded Medicaid, an estimated three million poor adults fall into the “coverage gap” where their incomes are above current Medicaid eligibility limits but below the lower limit of premium credits on the healthcare exchanges. The bulk of people in the coverage gap are concentrated in the South, with Texas (766,000 people), Florida (567,000), Georgia (305,000) and North Carolina (244,000) having among the highest number of uninsured.[61]The ACA included a number of other provisions to improve healthcare access and affordability. The law banned lifetime monetary caps on insurance coverage for all new plans and prohibited plans from excluding children and most adults with preexisting conditions.[62] Insurance plans are also prohibited from cancelling coverage except in the case of fraud, and are required to rebate customers if they spend less than 85 percent (80 percent for individual and small group plans) of premiums on medical services. Additionally, the ACA established the Prevention and Public Health Fund to allocate $7 billion towards preventative care such as disease screenings, immunizations, and pre-natal care for pregnant women and between 2010 and 2015. Furthermore, $11 billion in funding for community health centers and $1.5 billion in additional funding for the National Health Service Corps was included in the law.[63]A number of cost control provisions were included in the ACA in an attempt to curb rising medical costs. Among them is the Independent Payment Advisory Board, which will provide recommendations to Congress and the President for controlling Medicare costs if the costs exceed a target growth rate. The administrative process for billing, transferring funds, and determining eligibility is being simplified by allowing doctors to bundle billing for an episode of care rather than the current ad hoc method. Additionally, changes were made to the Medicare Advantage program that would provide bonuses to high rated plans, incentivizing these privately-operated plans to improve quality and efficiency. Furthermore, hospitals with high readmission rates will see a reduction in Medicare payments while a new Innovation Center within the Centers for Medicare and Medicaid Services was created to test new program expenditure reduction methods.[64]Common Methods to Lower Health Care CostsBy taking an international perspective and looking to other advanced industrialized countries with nearly full coverage, much can be learned. While methods range widely, other OECD countries generally have more effective and equitable health care systems that control health care costs and protect vulnerable segments of the population from falling through the cracks. Among the OECD countries and other advanced industrialized countries, there are three main types of health insurance programs:A national health service, where medical services are delivered via government-salaried physicians, in hospitals and clinics that are publicly owned and operated—financed by the government through tax payments. There are some private doctors but they have specific regulations on their medical practice and collect their fees from the government. The U.K., Spain, and New Zealand employ such a system. [65]A national health insurance system, or single-payer system, in which a single government entity acts as the administrator to collect all health care fees, and pay out all health care costs. Medical services are publicly financed but not publicly provided. Canada, Denmark, Taiwan, and Sweden have single-payer systems.A multi-payer health insurance system, or all-payer system, which provides universal health insurance via “sickness funds,” used to pay physicians and hospitals at uniform rates, thus eliminating the administrative costs for billing. This method is used in Germany, Japan, and France.[66]A universal mandate for health care coverage defines these systems. Such a mandate eliminates the issue of paying the higher costs of the uninsured, especially for emergency services due to lack of preventative care.[67] Other methods for reducing costs may include:Funding health care costs in relation to income rather than risk or people’s medical history.[68]Negotiating the price of prescription drugs and bulk purchasing of prescription medications and durable medical equipment is a method used in other countries for lowering costs. This has been effectively used by the U.S. Department of Veterans Affairs, Medicaid, and Health Management Organizations in the U.S. Yet, it has been prohibited by law from traditional Medicare. Savings of up to five percent of total health care expenditures could result from the full adoption of these practices.[69]An International Case Study: How Germany Pays for Health CareGermany has one of the most successful health care systems in the world in terms of quality and cost. Some 240 insurance providers collectively make up its public option. Together, these non-profit “sickness funds” cover 90 percent of Germans, with the majority of the remaining 10 percent, generally higher income Germans, opting to pay for private health insurance. The average per-capita health care costs for this system are less than half of the cost in the U.S. The details of the system are instructive, as Germany does not rely on a centralized, Medicare-like health insurance plan, but rather relies on private, non-profit, or for-profit insurers that are tightly regulated to work toward socially desired ends—an option that might have more traction in the U.S. political environment.[70]The average insurance contributions to German sickness funds are based on an employee’s gross income, around 15.5 percent with an income cap at $62,781, and employers and employees each pay about half of the premium. Generally, an individual employee’s contribution is 8.2 percent and the employer pays the remaining 7.3 percent.[71] [72]Premiums are not based on risk and are not affected by a person’s marital status, family size, or health. Germans have no deductibles and low co-pays.[73]Doctors are private entrepreneurs and get a fee from insurers for every visit and procedure they perform. However, they are tightly regulated. Groups of office-based physicians in every region negotiate with insurers to arrive at collective annual budgets. Doctors must remain in these budgets, as they do not receive additional funding if they go over. This helps keep health care costs in check and discourages unnecessarily expensive procedures. The average German doctor also makes about one-third less per year than in the U.S., around $123,000.[74]Government general revenues cover premiums for children, on the premise that the next generation should be the entire nation’s fiscal responsibility, instead of just the responsibility of the parents.[75]Germany reformed its coverage for prescription drugs in 2010 after costs for prescription drugs continued to rise. Prior to reforms, drug companies set the price for new drugs and were not required to show that the new drug was an improvement over previously available prescription drugs. Pursuant to the reforms effective in 2011, manufacturers could set the price for the first 12 months a new drug is on the market. “As soon as the drug enters the market, a new process of benefit assessment begins.” Manufacturers must establish, through comparative effective research that the new drug has an “added benefit to the patient, compared to the previously existing standard treatment.” Drugs without added benefit will be reimbursed according to a government pricing list. New drugs without added benefits are available to patients, but the patient has to pay the price difference. For drugs with added benefit, a price will be negotiated between health insurers and the manufacturer.[76]Quality of U.S. Health Care in an International ContextU.S. health care specialists are among the best in the world. However, treatment in the U.S. is inequitable, overspecialized, and neglects primary and preventative care.[77] The end result of the U.S. approach to health care is poorer health in comparison to other advanced industrialized nations. According to the Commonwealth Fund Commission, in a 2014 comparison with Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., the U.S. ranked last overall. In terms of quality of care, the U.S. ranked fifth, but came in last place in efficiency, equity, and healthiness of citizens’ lives.[78]Comparing other health care indicators in an international context underscores the dysfunction of the U.S. health care system.Despite the relatively high level of health expenditure, in the U.S. there are fewer physicians per capita than in most other OECD countries. In 2013, the U.S. had 2.6 practicing physicians per 1,000 people—below the OECD average of 3.3.[79]In the U.S., there are only about 1.2 primary care physicians per 1,000 people. Projections indicate that the U.S. will need 52,000 more primary care physicians by 2025 to meet demand.[80] While population growth and aging make up a substantial proportion of this increased need, expanded access to insurance under the Affordable Care Act means more people will seek out treatment. Therefore, there are provisions in the legislation to increase the number of primary care physicians in the U.S.There is a significant spatial mismatch within the United States for physicians as well. While the U.S. averaged 225.6 doctors active in patient care per 100,000 people in 2014, there is a wide variance across states; Massachusetts ranks highest with 349.5 active doctors per 100,000 people, while Mississippi has only 170.3.[81]In 2013, the U.S. infant mortality rate was 5.96 per 1,000 live births[82], while the OECD median was 3.8.[83]The obesity rate among adults in the U.S. was 35.3 percent in 2013, down slightly from 36.5 in 2011. This is the highest rate among OECD countries. The average for the OECD countries was 19.0 percent in 2013.[84]Thanks

You can apply in three ways, from the online official website, by phone and by letter.Here is the information from the Hawaii Med Quest website:WARNING, THIS IS LONG!!! Med-QUESTMED-QUEST DIVISION (MQD): HEALTH INSURANCE & LONG-TERM CARE FOR LOW-INCOME ADULTS AND FAMILIESThe State of Hawaii Med-QUEST Division (MQD) provides eligible low-income adults and children access to health and medical coverage through managed care plans. The QUEST program is designed to provide Quality care, Universal access, Efficient utilization, Stabilizing costs, and to Transform the way health care is provided to recipients.TO VISIT THE FULL Med-QUEST WEBSITE CLICK HEREApplications for Health Care Coverage are accepted:On-line at www.mybenefits.hawaii.govOver the phone at 1-877-628-5076By mail delivered to Med-QUEST Division Eligibility Offices [/box]Updated Notice – Services for children under 21, including autism servicesFee-For-Service – Long Term Care2015 Hawaii Med-QUEST Health Plans2020 Hawaii Federal Poverty Level (FPL) GuidelinesResources for ProvidersSpecial Enrollment Periods2015 Annual Plan Change Deadline Extended to October 30, 2015MQD Accomplishments 2010-2014Grievance Hotline Call 692-8094. Leave a message along with your name and contact phone number. A staff person from our Med-QUEST Division will call you back within 24 hours or the next business day.QUEST INTEGRATION PROGRAMThe Department of Human Services Med-QUEST Division (MQD) has launched, QUEST Integration, a more patient-centric Medicaid program to better serve clients. QUEST Integration effectively combines and replaces the QUEST and QUEST Expanded Access (QExA) programs.The benefits of QUEST Integration include more health plan choices for aged, blind or disabled individuals, and a greater ability for a beneficiary to remain with the same health plan upon turning 65 or developing a disability. Additionally, eligible beneficiaries will gain expanded access to home and community-based services to prevent decline to institutional level of care. QUEST Integration also reduces administrative burden by creating a single managed care program.Step 1: Learn About Your ChoicesChoosing a health plan is important. You’ll get all your health care services from a single health plan. The health plan can help you find doctors, hospitals, and pharmacies.When you’re choosing a health plan, it’s a good idea to see if you can:Keep seeing your current doctors.Go to the hospital, care facility, or pharmacy you prefer.Health Care Provider NetworkThe health plans participating in QUEST Integration are AlohaCare, Hawaii Medical Service Association (HMSA), Kaiser Foundation Health Plan (Oahu & Maui only), ‘Ohana Health Plan and UnitedHealthcare Community Plan. (See below for contact information). If there’s a specific provider you want to see, visit the QUEST Integration health plans’ websites, or call to ask if the provider is in their network.If your current provider doesn’t accept QUEST Integration (Medicaid) health insurance, call your health plan to help you find another doctor or provider.Health PlansPhoneWebsiteAlohaCare1-877-973-0712AlohaCare - HomeHMSA1-800-440-0640Hawaii Medical Service AssociationKaiser Permanente1-800-651-2237Home Page | KP in Hawaii‘Ohana Health Plan1-888-846-4262http://ohanahealthplan.comUnited Healthcare Community Plan1-888-980-8728HomeStep 2: Choose a Health PlanWhen you become eligible for Medicaid, the Department of Human Services assigns you to a health plan right away. You can stay with the health plan that Med-QUEST assigned to you or you can choose a different health plan.If you stay with your assigned health plan, you don’t have to do anything.If you choose a different health plan, you must:Tell Med-QUEST Enrollment Services Section of your new choice within fifteen days of receiving a choice notice from them.Your new health plan will start on the first day of the following month. Until then, you’ll stay with the health plan you were assigned.If you stay with your assigned health plan or choose a different health plan, you can change plans once within 60 days of the day you are enrolled in QUEST Integration. Once the 60-day period ends, you can change your health plan only during open enrollment.How many health plans can I choose from?Your five choices for a QUEST Integration health plan are:Aloha CareHMSAKaiser Permanente (Oahu and Maui only)‘Ohana Health PlanUnited Healthcare Community PlanGET STARTED WITH YOUR NEW PLANAfter you choose a QUEST Integration health plan, your plan will mail you:ID cards for each family member.Instructions to choose a primary care provider (PCP).Health plan responsibilities, services, and benefits handbook with information on:Interpretation and translation services.Prior approval for care and other services.Services the plan doesn’t cover because of moral or religious reasons.The grievance and appeal process.Make sure you carry your QUEST Integration health plan ID card and Medicaid ID card at all times. You’ll need your ID cards to get health care services.Getting care before you receive your health plan member ID cardYou’ll get a notice in the mail that tells you about the health plan you’re enrolled in. Take the notice with you to your doctor or other service provider to get medical care. Once you get your health plan ID card, you can use your card to get services.Choosing a primary care provider (PCP)Your health plan will mail you a welcome packet. Inside the packet you’ll find a form asking you to choose a primary care provider (PCP). Your PCP will see you for regular checkups or when you’re sick. When you need a specialist or other medical services, your PCP will arrange it for you. If you need help finding a PCP or specialist, ask your health plan for help.If you received services before you got the Med-QUEST enrollment notification, tell your PCP or other service provider. Your health plan may cover some of these services.You’ll have 15 days to choose your PCP. If you don’t let your health plan know of your choice within that time, they’ll assign you a PCP. You can change your PCP at any time.LEARN ABOUT YOUR QUEST INTEGRATION BENEFITSPrimary & Acute Care ServicesDialysisMedical transportation servicesDurable medical equipment and medical supplies with prosthetics and orthoticsOutpatient hospital servicesEmergency and post stabilization servicesPhysician servicesFamily planning servicesPregnancy-related servicesFluoride varnish for childrenPrescription drugsHabilitation servicesPreventive servicesHome health servicesRadiology, laboratory, and other diagnostic servicesHospice servicesRehabilitation servicesInpatient hospital medical and surgical servicesSmoking cessation servicesInpatient hospital maternity and newborn care servicesUrgent care servicesMedical services related to dental needsVision and hearing servicesBehavioral Health ServicesAcute inpatient hospital for behavioral health servicesServices from qualified professionals like psychiatrists, psychologists, counselors, social workers, registered nurses, and othersAmbulatory mental health servicesSubstance abuse treatment programsPrescribed drugs including medication management and patient counselingMethadone treatment services, which include the provision of methadone or a suitable alternative (e.g., LAAM)Psychiatric or psychological evaluationLong Term Services & Support (LTSS)Nursing facilityHome- and community-based services including:ChoreAdult day healthPersonal careAdult day carePersonal emergency response systemSkilled nursingResidential care like Community Care Foster Family Home or Expanded Adult Residential Care HomeDoes QUEST Integration cover medical and bills I already have?If you utilized medical services occurring a maximum of 10 calendar days before the date we receive your application, those services will be covered if a medical provider provided the medical service. Make sure that you check off the box asking about outstanding medical bills when you submit your application.After I choose my medical plan, will I have to stay in that plan forever?No. You may change your medical plan once a year during the “Annual Plan Change Period,” with changes effective January 1. Except during this annual plan change period and some exceptions, you must stay in your medical plan once you have chosen them.Are you under 21 years of age? Get free physical exams!The Early Periodic Screening, Diagnostic, and Treatment (EPSDT) program lets children and young adults under 21 get free:Complete medical and dental exams;Developmental, autism, and lead screening;Hearing, vision, and laboratory tests; andImmunizations and tuberculosis skin tests.The notice here will provides more information about other covered services that you may take advantage of, including autism services. You’ll also get help setting up appointments and arranging transportation. Call your health plan for more information.Urgent care centersIf you can’t get an appointment with your PCP, you can go to an urgent care center. Urgent care centers can treat you for an illness or injury that requires immediate care, but isn’t serious enough to visit an emergency room. You don’t need an appointment to be treated at an urgent care center.After-hours care nurse lineEach health plan has its own after-hours care nurse line, where you can get medical advice and guidance. The lines operate 24 hours a day, seven days a week.Call your plan’s nurse line if you have questions about a medical condition or you’re not sure if you should visit an emergency room.Traveling off-island or out of stateYour QUEST Integration health plan covers medically necessary off-island and out-of-state emergency services and post-stabilization services. For non-emergency off-island, out-of-state, and out of network services, you’ll need prior authorization. Medical services in foreign countries are not covered.Other Health CoverageYou must notify MQD is you have additional health insurance.SERVICES THAT AREN’T COVERED BY YOUR HEALTH PLANCall 1-800-316-8005 toll-free for more information about these services.ServiceWho provides it?DentalMedicaid Fee-For-ServiceSchool healthDepartment of Education (DOE)Zero to Three programDepartment of Health (DOH)Behavioral health services for adults enrollees with serious mental illness (SMI)Adult Mental Health Division (AMHD) in DOH or Community Care Services (CCS)Behavioral health services for children under 21 years old with serious emotional disturbances (SEBD)Child and Adolescent Mental Health Division (CAMHD) in DOHServices for developmental or intellectual disabilitiesDevelopmental Disabilities Division (DDD) in DOHAbout dental services and benefitsThe Medicaid Fee-For-Service program provides dental services. This means you must get dental care from a dentist who sees Medicaid patients.Call Community Case Management Corp (CCMC) to find a dentist who accepts Medicaid.Oahu: 792-1070Neighbor Islands: 1-888-792-1070 toll-freeIf you’re under age 21, you get:Diagnostic and preventive services once every six months.Non-emergency care that includes:Endodontic therapyPeriodontic therapyResotrationsProsthodontic servicesOral surgeryEmergency servicesIf you’re 21 or older, you get:Emergency services that include:Eliminating dental painEliminating dental infectionTreating acute injuries to the teeth and supporting structuresWHO TO CALL FOR WHICH SERVICESCall your health plan if you have:Problems with a doctor or other provider.Problems accessing health care services.A disagreement about your health plan.A grievance or appeal to file.Call Med-QUEST Enrollment Services Section at 1-800-316-8005 toll-free if you have health plan enrollment and eligibility questions. TTY users, call 1-800-603-1201 toll-free.Member complaints and grievancesAll health plans have a member grievance and appeals process to help address any problems. If you’re concerned about your medical care or services, contact your health plan’s customer service department. The phone number is printed on the back of your membership card.If you can’t work things out with your health plan, you can contact the state-designated QUEST Integration Ombudsman in your county. The ombudsman can help if you have problems with your health plan or don’t agree with the health plan.Hawaii: 333-3053Kauai: 240-0485Maui and Lanai: 270-1536Molokai: 660-0063Oahu: 791-3467Online: HilopaʻaIMPORTANT QUEST INTEGRATION CONTACT INFORMATIONHave health plan enrollment questions?Call Med-QUEST Enrollment Services Section at 1-800-316-8005 toll-free, 7:45 a.m. to 4:30 p.m., Monday-Friday, except state holidays. TTY users, call 1-800-603-1201 toll-free.Provider Resources: www.med-quest.usMailing address: Med-QUEST, P.O. Box 700190, Kapolei, HI 96709-0190Have changes to report or health plan eligibility questions?Call the Med-QUEST Division Eligibility Offices to report all changes within 10 days of learning of them. If you don’t report changes, it may affect your eligibility for medical assistance. Changes include:IncomeAddressLiving arrangementMarriage or divorcePregnancyBirthDeathHealth insurance coverageGetting or changing a jobInjuries from accidentsReceipt or sale of any assetReceipt of a Social Security numberYou must also report when you enter a hospital or public institution or move out of the state of Hawaii.Oahu PHONE FAXApplications 587-3521 587-3543Ongoing 587-3540 587-3543Kapolei Unit 692-7364 692-7379Hawaii IslandHilo (East Hawaii) 933-0339 933-0344Kona (West Hawaii) 327-4970 327-4975Maui 243-5780 243-5788Kauai 241-3575 241-3583Molokai 553-1758 553-3833Lanai 565-7102 565-6460After I choose my medical plan, will I have to stay in that plan forever?No. You may change your medical plan once a year during the “Annual Plan Change Period,” with changes effective January 1. Except during this annual plan change period and some exceptions, you must stay in your medical plan once you have chosen them.How do I know when to contact the State and when to contact my plan? You should contact the State if:you have a question about eligibilityyou get a job or change jobsyour income, assets or address changeyou have a change in your family, such as a birth, a death, a divorce, a marriage or someone moves into or out of your homeYou should contact your plan if:you have questions about how to get the care you needyou lose or misplace your medical cardyou need special assistanceI hope this is the information you are looking for.Aloha from suburban Makawao, Maui Hawaii