AGENCY-SPECIFIC GOALS

Environmental Management

A half century of nuclear weapons production and energy research, much of which occurred prior to the national commitment to a clean environment as a top priority, have left large amounts of radioactive contamination and hazardous waste at 114 sites in 31 States and one U.S. territory. By the end of 2005, DOE is scheduled to have cleaned up 79 of these sites, with the largest and most challenging site cleanups remaining.

Reforms Clear Major Hurdle

Recently enacted legislation will allow DOE, subject to Nuclear Regulatory Commission coordination, State permits, and judicial review, to proceed with its plans to accelerate treatment and disposal of certain wastes at sites in Savannah River, South Carolina, and in Idaho. The legislation allows DOE to empty and treat wastes from underground storage tanks to the greatest extent practicable, and to leave in place stabilized residual waste that meets low-level waste disposal standards. Safe and secure on-site disposition of these wastes will allow taxpayers to avoid tens of billions of dollars in additional costs.

For many years the Environmental Management (EM) program failed to achieve its risk-reduction mission, was unable to effectively control cost and schedule overruns, and experienced significant problems in project management and contract administration. However, under the Administration's aggressive reform initiative, program performance is beginning to turn around:

• DOE (including NNSA) expects to accelerate cleanup completion by 35 years and save $54 billion (reducing the estimated total cost to clean up these sites from $196 billion to $142 billion).

• New acquisition strategies focus on unbundling work, using small businesses, competing contracts, and rewarding excellent performance.

• An effective workforce strategy has reduced the workforce necessary for cleanup by 39 percent since 2000-retaining capable employees and increasing management accountability.

The 2006 Budget provides $6.5 billion for the EM program to continue implementing reforms that will accelerate the reduction of risk to the public and the environment, and provides $222 million for clean-up and waste management of seven sites transferred in 2006 from EM to NNSA. The Budget also provides the funding needed in future years to ensure success of this important environmental initiative.

• Promoting national health care information technology, with the goal of most Americans having an electronic health record with proper medical privacy protection by 2014.

• Proposing a comprehensive, consumer-driven plan to address the problems of rising health care costs and the uninsured. This plan includes: Health Savings Accounts; Association Health Plans; tax credits; and medical liability reform.

Protecting America

• Strengthening the Nation's preparedness against bioterrorism, through biodefense research and development, biosurveillance early warning systems, hospital and public health preparedness, and defense against intentional contamination of the Nation's food supply.

• Improving the ability to respond to bioterrorism through a new initiative to improve mass casualty care after a catastrophic incident, and augmenting the Strategic National Stockpile of pharmaceuticals and other medical supplies.

Supporting a Compassionate Society

• Ensuring access through Health Centers to high-quality primary and preventative health care for low-income individuals.

MEETING PRESIDENTIAL GOALS-Continued

Helping healthy families through initiatives that support marriage, provide assistance to parents, and encourage the development of family-support programs run by community organizations.

Strengthening and modernizing health care and offering drug coverage for approximately 42 million senior citizens and persons with disabilities through the Medicare program.

• Providing quality health care in a cost-efficient manner to over 46 million low-income individuals, elderly individuals, and individuals with disabilities through the Medicaid program.

• Providing health care coverage to a total of approximately 5.8 million low-income, uninsured children through the State Children's Health Insurance Program.

• Proposing a health insurance tax credit so that millions of Americans will have access to affordable health care.

• Enrolling as many uninsured, eligible children as possible into Medicaid and the State Children's Health Insurance Program through the President's Cover the Kids proposal.

Making Government More Effective

Developing additional decision support tools at the National Institutes of Health to improve the management of its large and complex scientific portfolio and to better integrate research across its 27 Institutes and Centers.

Strengthening Medicare program integrity by preventing overpayments, accelerating contractor reform, and rationalizing payments for bad debt.

• Increasing efficiency and lowering costs for Medicaid prescription drugs.

• Proposing to build on past efforts to improve efficiencies and the fiscal integrity of Medicaid and State Children's Health Insurance Program.

PROMOTING ECONOMIC OPPORTUNITY AND OWNERSHIP

Health Information Technology

The Administration is strongly committed to advancing quality, consumer-driven health care and encouraging collaboration and productivity in the medical services sector. The newly created Office of the National Coordinator for Health Information Technology (HIT) at the Department of Health and Human Services (HHS) coordinates Federal efforts across many initiatives and activities, including:

• Advancing the adoption of HIT by physicians, hospitals, and other providers;

Implementing electronic prescriptions as mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003;

• Developing models for the exchange of Electronic Health Records (EHRs) and other health data nationally and with proper medical privacy protection; and

• Identifying standards and the mechanisms for broad adoption of EHRs.

The 2006 Budget includes $125 million to continue progress in this area, including $75 million in the Office of the Secretary to foster collaboration and develop the conceptual framework and infrastructure for a nationally interoperable HIT network that would interconnect clinicians, personalize care, and improve public health surveillance.

Promoting Affordable Health Care

Rising health costs are an impediment to job and wage growth. When health care costs rise, employers have less to spend on new employees, or on salaries for their existing employees. Rising health care costs impose a burden on families and small businesses and put coverage out of the reach of many Americans. Many businesses-particularly small firms-are struggling with these rising costs. According to the Census Bureau, 45 million people lacked health insurance coverage in 2003, including 8.4 million children.

The President has proposed a comprehensive, consumer-driven plan to address the problems of rising health care costs and the uninsured. His plan includes: Health Savings Accounts (HSAs); Association Health Plans (AHPs) for small businesses, civic groups, and community organizations; tax credits for low-income families; medical liability reform; and electronic health records for all Americans within 10 years.

The President's plan will help reduce the rising cost of health care while improving quality and safety. It will provide new and affordable health coverage options for all Americans-targeted to those who need it most: low-income children and families; employees of small businesses; and the self-employed.

Health Insurance Tax Credit. The President proposes a tax credit that will help individuals purchase health insurance and health care. The proposal provides greater choice of insurance products and encourages saving for future health expenses. Individuals under age 65 who are not enrolled in public or employer-sponsored health plans would be eligible. The credit would be refundable and could be paid in advance directly to the health plan. The amount of the credit would depend on an individual's income level. The credit would phase out at incomes of $30,000 for an individual and $60,000 for a family.