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National Association of Counties 2010 Legislative Conference

Washington, DC, March 9, 2010

Thank you, Valerie Brown, for that kind introduction, and thank you NACo, for working so hard to make sure that counties are able to deliver the health and human services that are so critical to communities today.

I want to congratulate all of you on celebrating your 75th anniversary.  There are a lot of similarities between 2010 and 1935 when NACo was founded.  Back then, the economy was recovering, but Americans were still struggling with high unemployment and wondering when things were going to get better.

And even though we had extraordinary leadership here in Washington with President Franklin Roosevelt, we still needed the county officials who were dealing directly with problems, to come to Washington and speak with one voice about what was necessary to improve people’s lives.

That’s because we knew that real change starts at the local level.  And that’s something that hasn’t changed.

I can’t think of a better example of how critical county governments are than your response to H1N1 flu.

Now, we worked hard the federal level.  As soon as we identified the new H1N1 strain last spring, we deployed government scientists and worked with manufacturers to develop a vaccine.  We got it out the door less than six months after the flu was identified and got the word out to groups at greatest risk that they needed to get vaccinated.

We distributed hundreds of millions of dollars for Public Health Emergency Response and Hospital Preparedness, so county and city health departments and hospitals had the resources you needed in case there was a surge of illness.

Without your distribution systems, your personnel, and your outreach efforts, we wouldn’t have had this success. So far, 97 million shots in arms and squirts up noses have protected approximately 86 million people from H1N1 flu this year. Combined with the more than 100 million people who got a seasonal flu vaccine, we’ve had unprecedented levels of immunization during the 2009-2010 flu season.

So I want to thank you.

And I also want to give you some good news from our scientists.  Next year, the H1N1 strain will be included with the seasonal flu vaccine, so people won’t need two shots.  But though cases are declining, the 2009 season still isn’t over.  Flu is still circulating, so you need to let people know that it’s still important to get vaccinated if you haven’t had your flu shot yet.  

Your work getting vaccine out during the flu pandemic is just one example of how important county services are to people in this country.  And I know that recently, that job has gotten a lot harder.  At a time when people need those services more than ever, many of you have had fewer resources to provide them.

That’s why one of the first bills the President signed was a Recovery Act that provided critical aid to help families weather the recession, and overdue investments to lay the foundation for future growth.

Recovery Act money for the Temporary Assistance for Needy Families Emergency Fund helped low-income Americans across the country get jobs.  In places as different as New York City, North Dakota, Oklahoma, and San Francisco, Recovery Act programs helped people on public assistance, kids aging out of foster care, and parents of kids with TANF become self-supporting.

We’d like to see NACo members work with state TANF agencies to start up more of these subsidized jobs programs using TANF emergency funds.

The Recovery Act also made sure people wouldn’t lose Medicaid or their COBRA health insurance as they fought to get back on their feet.  We hope Congress will enact the President’s budget proposal so that states continue to see fiscal relief in the form of the enhanced Medicaid match.

But just as importantly, the Recovery Act started us on the road to making some lasting changes in health care delivery that will increase access to care, improve quality, and bring down costs.

The Recovery Act made a major investment in community health centers, which provide millions of Americans with high quality primary care.  It had money to expand the country’s health care workforce so we can increase the capacity of nursing schools, help more low-income and minority students realize their dreams of becoming doctors, and make sure rural Americans get care when they need it.

The Recovery Act made a historic investment in health IT.  Time after time, electronic health records have been shown to cut costs, eliminate paperwork, and most of all, give doctors more time to spend with their patients so they can deliver high-quality, coordinated care.

Yet despite these benefits, just 20 percent of doctors and 10 percent of hospitals have even basic electronic health records systems.

To change that, we’ve providing $375 million in Recovery Act funds to create 32 Health IT Regional Extension Centers around the country.  These centers will work like Agricultural Extension Centers did for American farmers.

They’ll be local and regional organizations where doctors can go with questions, whether it’s which health record system fits your needs or how to get the most out of it once it’s installed.  Eventually, we hope these centers will support more than 100,000 primary care providers around the country, particularly small practices in isolated areas.

We’re also providing a second group of grants totaling more than $385 million that will help states develop the policies and frameworks that allow health information to be securely exchanged across providers and hospitals.

And we’ve set aside additional funds to create incentives for doctors to adopt these records and use them to deliver better care.

These are just a few examples of the progress we’re making to improve health care delivery for every American.

And, thanks to the Recovery Act we’re taking some solid steps forward with prevention.  We’ve made hundreds of millions of dollars available as part of a comprehensive prevention and wellness initiative, Communities Putting Prevention to Work.

This new initiative supports local efforts to reduce obesity, increase physical activity, improve nutrition, and decrease smoking—the four most important things we can to do to fight chronic diseases and improve public health. It’s right in line with the First Lady’s Let’s Move campaign, which calls for state, local and community leaders; parents, teachers, grocers, and businesspeople to work together to solve childhood obesity in a generation.

Today, one in three American children is overweight or obese, and they are likely to become obese adults with a long list of obesity-associated chronic conditions. Smoking, and second-hand smoke, is still the number one cause of preventable death in the U.S.  

We need counties’ help to create communities and environments where healthy choices are more affordable and accessible.  Every state received a grant from Communities Putting Prevention to Work. Please find out how you can join in.

Building a true health system which supports people’s efforts to stay healthy is one important way to reduce the high cost—both human and financial—of illness in this country.  Right now, we already spend about one out of every ten health care dollars on obesity and its complications.  

But we also have to fix a health insurance system that prices Americans out of the care they need when they get sick.  I want to thank President Brown for her leadership— and NACo for its partnership—in fighting for comprehensive health insurance reform.

With the news of jaw-dropping double-digit rate increases in individual and small group insurance that companies are proposing this year, we don’t need to be reminded of what we have to look forward to if we don’t pass health insurance reform.  And even while consumers are seeing double-digit increases in their premiums, the top five health insurers are reporting $12.7 billion in profits for 2009.

So last week I called a meeting with the CEOs of the 5 biggest insurance companies.  I felt they owed the American people an explanation.

The president stopped by our meeting briefly, and brought a letter from a woman in Ohio who is paying $7,000 in health premiums. She's also paying about $4,000 more in out-of-pocket costs for various prescriptions and health needs this year.

She is a cancer survivor and has been cancer-free for 11 years.  She just got notice that her rates will go up another 40 percent.  

Yesterday I sent my own letter to insurance companies and asked them to make public the justification for their rate increases. I think it’s pretty simple: if insurance companies are going to raise our rates, they ought to at least tell us why. So I called on these companies to give us some straight answers and some real data that demonstrate why their premiums are going up.

In the past few days, we’ve also heard from an analyst who was speaking on a conference call organized by Goldman Sachs. On the call, the analyst said competition in the insurance market is so weak, insurance companies can continue to raise rates with the confidence that their customers have nowhere else to go.

This kind of system isn’t acceptable and isn’t sustainable.

That’s why President Obama is determined to build on the progress we’ve made so far and pass health insurance reform this year. And we are moving ahead.  

The President has proposed health insurance reform legislation that takes the best of the House and the Senate’s bills as well as good Republican ideas.  It lays out rules of the road to prevent insurance company abuses and denial of care.

It would make insurance more affordable for families and small businesses.  Help tens of millions of Americans get coverage.  Create a new health insurance marketplace that will make it easy for families to shop for and compare different plans, and give Americans the security that they will always be able to find affordable coverage, even if they lose or change jobs.

It would also put our budget on a more stable path, reducing the deficit by $100 billion over the next ten years.

Outside of Washington beltway, there’s no question we need health insurance reform.  And I’m confident that eventually, we’re going to see legislation on the President’s desk that provides it.  But in the meantime, there are things we can do today to increase access to health coverage.  There is no need to wait.

One of these steps is to find and enroll every uninsured child who is eligible for CHIP or Medicaid. These programs are the key reasons that the parents of 40 million kids all over the country have not had to worry about whether they can afford a visit to the doctor during this recession.

But there are five million more who are eligible for Medicaid or CHIP, but aren’t enrolled.  This morning, I want to challenge every member of NACo to help us find these kids and connect them to coverage.  

This can be as easy as what they did in Hamilton County, Ohio.  They let families use the fax machines at over 40 public libraries at no charge, to fax in their paperwork for Medicaid and CHIP.  It saved the families the trip down to the county welfare office to apply for health coverage, and now their kids can get care.

We’re doing what we can to help you.  My department has awarded $40 million in outreach grants to help find eligible kids and enroll them, so they don’t have to put their doctor’s appointments off a day longer than they have to.  And, Secretary Tom Vilsack is working with us to ensure that kids enrolled in SNAP and school lunch programs are connected to health coverage through Medicaid and CHIP.

So, which counties want to take on the “Connecting Kids to Coverage” challenge with us?  Which counties will help us get the number of kids who are eligible but unenrolled down to zero?  Which county hospitals will partner with us to enroll every child born in the hospital in Medicaid or CHIP if they are eligible?

I urge you to step up to the plate.  Because working together, I’m confident we can enroll all five million kids in the next five years.

We need your help.  Your partnership has been and will continue to be critical on so many issues—pandemic flu, helping folks climb out of the recession, building healthier communities, and achieving health insurance reform.

You’ve been fighting for these issues and the American people since 1935.  And we need your voices in Washington and your action back home to keep on making a difference for people.  

I opened by mentioning President Franklin Roosevelt so I’ll close with something he said, which applies to health reform and all of these issues.  He said:   “In seeking economic and political progress, we all go up—or else we all go down.”

He also said, “Be sincere; be brief; be seated.”

Thanks for the opportunity to talk with you today.