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American Association of Colleges of Nursing

Washington, DC - November 3, 2009

Thank you Dr. Murray, for that warm introduction. And before I start, I want to congratulate the AACN on the good judgment to honor Dr. Mary Wakefield yesterday with the 2009 Policy Luminary Award, your highest award for achievement in public policy.

I’m very glad to be here this morning—we have the future of nursing here in this room. And although you’ve asked me to talk about “The State of Health Care,” there’s no one who actually knows the state of health care better than a nurse.

You’re in Washington at an incredibly important time. This week, health insurance reform legislation goes to the House floor. This is a tremendous accomplishment and it’s another sign that the momentum is on our side.

We’ve been fighting for health reform since the Roosevelt Administration—the Teddy Roosevelt Administration—and right now, we’re closer to reforming health care than we’ve ever been. The reason is simple: the country knows it’s time for a change.

Health insurance costs too much and people can’t afford the health care they need. If their coverage comes from an employer, they’ve seen insurance premiums more than double in the last nine years, rising three times faster than wages.

It’s not easy for employers either. For many small business owners, health care is their highest expense, just behind salaries.

Over 80 percent of the 47 million Americans without insurance come from working families. Half of all personal bankruptcies are at least partly the result of medical expenses.

But it isn’t enough to provide coverage that simply pays for treatment after someone gets sick. Health reform also means shifting the balance from “sick” care to well care. Three-quarters of the $2 trillion we spend on medical care is spent on chronic disease. More chronic illness could be prevented—if we would make it a priority.

Obesity is a good example of what I mean by “shifting the balance.”

Over two thirds of American adults—and almost one out of every three American children—are obese or overweight. Obesity increases your risk of heart disease, certain cancers, and stroke. Obesity is the single biggest predictor of diabetes.

Obesity costs our health system as much as $147 billion a year…a number that has almost doubled since the last time the CDC looked at it in 1998.

To put that figure in perspective, the American Cancer Society estimates that all cancers combined cost our health care system $93 billion a year. Ending obesity would save our health care system more money than curing cancer.

But just making a dent in the obesity epidemic could mean real gains—both in dollars saved and in quality of life.

That’s why you are so important to health care reform.

You’re the health care professionals patients most often see. You’re the ones conducting important research on issues like obesity. You’re the ones who give patients the personal contact, interventions, and education they need to help them heal. You pull health care teams together and coordinate patient care. You check back with patients to make sure they’re doing what’s important to stay well.

And you’re on the front lines, so you know better than anyone that we can’t wait for real reform.

Now, even in the best of times there aren’t enough nurses to go around. But today, we’re in middle of a workforce crisis.

The need for more nurses is enormous—this Administration knows that. Over the next decade, nurse retirements and an aging U.S. population will create the need for hundreds of thousands of nurses by 2025. But we intend to meet the demand, with nurses who have the professional skills and knowledge to provide 21st Century care.

We’re already making progress. The Recovery Act allocated $200 million to train an estimated 8,000 students and credentialed health professionals by the end of FY 2010— enough to provide health care for an additional 2.2 million people.

The Recovery Act dedicated more than $6 million in nursing scholarships for students from disadvantaged backgrounds. More than $13 million were dedicated to repay loans when nursing students choose to practice in critical shortage areas, and for nursing schools to support students who plan to teach nursing when they graduate.

The President’s budget also recommends $715 million for health professions, including another $5 million increase for Nurse Faculty Loans in 2010. This could underwrite as many as 50,000 nursing students who otherwise would not have had the opportunity to take advantage of this program. It proposes an $88 million increase to Nurse Loan Repayment and Scholarships, which could fund 580 new scholarships and 1,340 new loan repayment awards.

The 2010 Budget and the Recovery Act also increased the National Health Service Corps, which would put thousands of health care professionals into some of the neediest, most underserved communities in America as we move forward on health insurance reform.

We need more primary care professionals who look at the whole patient, who look for health problems before they become chronic diseases, and who work with so they can keep themselves and their children healthy.

The NHSC is not just for doctors and dentists. There are as many as 1,000 vacancies for advance practice nurses on the NHSC Job Opportunities site.

We need your help to connect your soon-to-be graduates with this program. Let them know that there’s never been a better time to explore this offer to pay down their student debt while serving Americans in need.

Another area where nurses are desperately needed, right now: to assist with the nationwide response to the 2009 H1N1 influenza.

Nurse educators and students are always on the front lines in these kinds of situations.

You’ve been there for the American people during so many other national emergencies. For example, during hurricanes Katrina and Rita, students from the University of Louisiana’s College of Nursing and Allied Health in Lafayette; Southern University’s School of Nursing in Baton Rouge, and Northwestern Louisiana State’s School of Nursing in Shreveport, not only provided care to people in emergency shelters, they made sure displaced people connected with the health care they needed.

We need you to provide the same kind of service this flu season.

As of Friday, 48 states reported widespread flu activity. Almost all of this is the H1N1 virus.

One of the most troubling aspects of the 2009 H1N1 influenza are the higher rates of severe illness among children than we normally see with seasonal flu. We’ve had 114 H1N1 confirmed pediatric deaths since the beginning of April, and that number is going to rise. We’ve seen deaths among pregnant women.

About half of hospitalizations for flu-like illness are for people UNDER the age of 24, compared to less than 10 percent of people over the age of 65. This is almost exactly the opposite of what we see for seasonal flu.

Nearly 90 percent of the deaths from H1N1 are people under the age of 65, which, again, is the opposite of what we see with seasonal flu.

The President has declared a national emergency to give health care providers the flexibility to respond. We don’t want the current wave of H1N1 virus to overburden you, the first responders.

We need your help, right now, to get the word out, especially to people in the priority groups who risk serious complications—

  • Pregnant women;
  • Children and young adults from 6 months to 24 years and people caring for babies under 6 months; and
  • People with underlying medical conditions such as asthma, diabetes, or neuro-muscular disorders.

Let them know how important it is to get vaccinated.

People really listen to nurses; surveys say you are the most credible sources of accurate medical information. We need you to let people know how important it is to protect themselves and their families, including simple things like cough etiquette, good hygiene, and staying home when they’re sick.

And we’re grateful for your help providing vaccinations in your communities.

These vaccines are safe; they’re manufactured by the same methods as the seasonal flu vaccines administered every year. And despite initial delays in manufacturing, more and more vaccine is rolling off of the production lines daily. Shipments to communities are increasing. Last week, in fact, almost double the amount of vaccine was ready for orders than had been the week before.

If you want the most up-to-date information on vaccine availability, as well as handouts and lists that will help you help others, go to is already getting a million and a half hits a week, a number that keeps rising. It has become one of the best resources we have for reaching people about prevention, treatment, and vaccines.

There is one, important, additional priority group for vaccination: health care workers.

I can’t say this any more strongly: every nurse needs to get both the H1N1 as well as the seasonal flu vaccine. You don’t want to spread the flu to someone who is vulnerable to serious illness. You do want to protect the people you work with and the people you love.

This country needs you out there on the front lines of health care. For health reform, for patient care, and to fight this H1N1 virus.

It’s been a pleasure to be able to be here this morning. Thank you for this opportunity and I’m looking forward to your questions.