Extent: 3.5 linear ft.
Boxes: 41 - 43
Content: Legislation, correspondence, news clippings, "Dear Colleague" letters, reports, staff
Arrangement: Arranged alphabetically by issue and chronologically within.
The series of Health and Human Services Issue Files comprises files on Medicare and Medicaid,
AIDS, Welfare Reform (see also Series I.A. TC Personal Files), and Health Care Reform as well
as lesser issues. These files highlight the broad range of issues that came before Congress during
Carper's ten years in the House. The Health and Human Services files are broken down into
smaller topical groups: General Issues, Disabilities, Health Care Reform, Medicare/Medicaid, and
General Issues contains information regarding the appropriation of funds for fiscal years
1990 through 1992 in areas such as AIDS research, Alzheimer's disease, alcohol and drug abuse,
and health care for the elderly, homeless, and mentally ill. Two notable issues in this category are
the Family and Medical Leave Act of 1990, and the general distribution of funds in 1991.
Congress wrangled over the issues of AIDS in the early days of anti-AIDS discrimination
legislation, and the attempt to create a satisfactory compromise for maternity, paternity, and
sickness leave. Carper co-sponsored many of the bills in this series and sponsored H.J. Res. 304,
designating the week of May 10, 1988 as Stuttering Awareness Week.
Disabilities files deal primarily with issues relating to the Americans with Disabilities Act
(ADA) of 1990 and some senior citizen concerns. ADA prohibited discrimination against people
with disabilities in employment, public accommodations, transportation, and telephone services.
It amended discrimination legislation passed in 1973 that prohibited discrimination against the
disabled in social services, education, and employment by the federal government, and any entity
receiving federal funds, by expanding this legislation to cover the private sector.
The Older Workers Benefit Protection Act of 1990, H.R. 3200, prohibited discrimination
against older workers regarding employee benefits. The Act was passed in response to the
Supreme Court decision in Public Employees Retirement System of Ohio vs. Betts (1989). This
case concerned a social worker, Mrs. June Betts, who had to leave her job because she was
suffering from Alzheimer's disease. She was denied disability pay because her employers said she
was over sixty and therefore not entitled to these benefits. Her family sued to get Mrs. Betts
disability benefits but the court ruled that, under the Age Discrimination in Employment Act of
1967, Mrs. Betts was not the victim of discrimination and therefore not entitled to disability
benefits. H.R. 3200 reversed the Betts decision and restored the policy that older employees be
provided with the same benefits unless the employer could prove that equal benefits would cost
more for older workers. (See also Series I.C.7. Civil Serice Issue Files.)
Two file groups contain information on Health Care Reform and Medicare/Medicaid. In
the late 1980s and early 1990s, Congress spent a good deal of time trying to find ways to expand
health care to uninsured or under-insured Americans, while trying to make America's health care
system safer, more cost efficient, and less expensive. Several issues are addressed in these files.
Among them are the "Pay or Play" proposals set forth by the Pepper Commission and the
Mitchell/Rostenkowski bill. According to the "Pay or Play" system, employers had to either
directly provide employees with health care or pay to have them covered by a public plan. The
"Pay or Play" system was opposed by Dr. Louis W. Sullivan, the Secretary of Health and Human
Services, because he believed that employers would provide insufficient health care and that the
system would "constitute a fatal step down the road to national health care." Congress was, at
the time, considering a system of national health care and the series contains studies and
comparisons of state-run health care systems in Canada, Japan, and Germany.
Other prominent issues covered in the subcategories of Health Care Reform and Medicare/
Medicaid include medical liability reform, occupational safety in health care, drug pricing under
Medicaid, services provided under Medicare/Medicaid, and the extension of Medicaid to pregnant
mothers and infants living below the poverty line. Much of the material here is composed of
background information that Carper studied prior to voting on legislation.
Welfare Reform completes the HHS files. Welfare Reform was a hotly contested issue
while Carper served in the House and one in which he had a strong interest. Legislation
introduced in March of 1987 by Congressman Harold Ford of Tennessee, the Family Welfare
Reform Act of 1987, H.R. 1720, was designed to assist and encourage families to achieve self-sufficiency. The bill proposed to replace the Aid to Families with Dependent Children (AFDC)
program with the Family Support Program (FSP), and encourage and assist needy children and
parents in obtaining the education needed to find employment and avoid long-term welfare
dependence. The goal was to get people off public assistance and into the workforce faster. The
bill would cost over $5 billion over a period of five years. This cost was a major sticking point as
Congress was also trying to pare the budget deficit, and new spending on an unpopular program,
such as Welfare, did not sit right with many members of Congress. The House Republicans
introduced H.R. 3200, a bill that cost slightly more than $1 billion and was more restrictive, but
had the support of the White House administration. Carper offered H.R. 3692 as a middle-ground approach. Costing a little over $2 billion, Carper's bill was described by supporters of
H.R. 1720 as little more than the Republican bill with a different number. Also standing in
Carper's way was the restrictive rule of the House on the Welfare Bill hearing which allowed for
no amendments; Carper had planned to offer his bill as an amendment in the nature of a substitute.
H.R. 1720 eventually passed the House and went to the Senate where it went into
Conference and eventually was signed into law October 13, 1988. The file containing Carper's
letter to state governors (F636) is a good example of how the Congressman's office worked.
Carper drafted, in longhand, correspondence that his staff annotated, revised, and sent back to
Carper for review.