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American Public Human Services Association National Spring Conference

March 29, 2010

Washington, D.C.

Good morning.  Thank you, Howard, for the introduction.  

Two of the really respected people in the field are here from the Department of Health and Human Services—Cindy Mann and Carmen Nazario—so you know what a terrific team we have behind us.

And on behalf of the Department, we’re delighted to be a part of this conference.  The programs you work with aren’t extras; you’re providing people with the building blocks for a good life.  There are a lot of people who pay lip service to the importance of children and families, but—day in and day out— you’re the ones working to make sure their needs are met.  

In an agency that does as many different things as ours, I just don’t have time to touch on many of the important areas we are working in, so my goal today is to give you some highlights about our priorities and about the way we are trying to work.

So if you don’t remember anything else, here’s what I want you to take away:

First, we’re investing in kids.  Everyone says “kids are the future” but if we don’t invest in their health care, in their developing brains, and their families, then this country will be less creative, less competitive, and our people will be less secure.

Second, we’re focusing on prevention.  I know it’s a cliché to say that an ounce of prevention is worth a pound of cure, but like so many clichés, it’s true.  And that’s why this department is taking prevention so seriously in a whole range of areas—from childhood obesity, to teen pregnancy, to home visiting.

Third, we’re fostering innovation.  We've learned a lot over the years about what works in health and human services and what doesn't, but we’re far from having all of the answers or solving all problems.  We have to pursue innovation vigorously so we can lay the groundwork for the best practices of tomorrow right now.

Fourth, we can’t do this alone.   From the moment the Obama Administration walked into the White House, one of our top priorities has been to forge strong working relationships with folks on the front lines.  So I want to thank you for keeping your doors open to us and I want you to know we’re committed to working as partners.   

While we all can be grateful that the country is beginning to climb out of the recession, families have been hit hard and so have your budgets.  Unemployment remains high and many people need a helping hand.

Meanwhile, states have fewer resources you can draw on to help them out.   As a former governor I know from experience that states’ budgets have to balance and they don’t get a pass because there’s an economic downturn. I’ve seen how health departments and human services agencies work very hard to be creative about doing more with less.  

But while my department—and all of you—work extremely hard to meet people’s short term needs, we don’t just offer a safety net. We’re also working to make their lives better in the long-term, by creating opportunity and improving health.

One of the most important things we can do to help this country reach its full potential is invest in our kids.

You can see the proof of our commitment in the President’s 2011 budget.  This is a tough budget that recognizes the fiscal difficulties facing our nation.  But while the President has proposed a three-year freeze on non-military discretionary funding overall, the budget finds room for investments we have to make if our families and our country are going to thrive.

The President’s budget invests in Head Start and Early Head Start.  Under the President’s plan, Head Start can serve 66,000 more young children than it did two years ago, and he would nearly double the numbers in Early Head Start.

The President would increase child care funding by $1.6 billion in 2011, funds which would provide child care assistance to approximately 235,000 more children in fiscal 2011 than you could serve without this support.

Of course, just serving more children is not enough – we have to serve them better and smarter.  This means raising the bar on the quality of child care and early education so all kids start school well on the road to healthy development—and it doesn’t matter whether they’re in child care, private preschool, public pre-K or Head Start.

The President’s Early Learning Challenge Fund would have supported states working toward a well-integrated, high quality, comprehensive early childhood education system, and we’re disappointed that it wasn’t included with education pieces of the reconciliation bill.  But you should know that we aren’t finished yet.  We’re going to continue to look for ways to move that proposal forward.

Another important investment in kids has been with the expansion and extension of CHIP.

Health coverage for children across the country has improved since the CHIP reauthorization and the Recovery Act went into effect. In fact, an additional 2.6 million children gained Medicaid or CHIP coverage during the 2009 fiscal year, mostly living in families with the lowest incomes.

That’s pretty good—but we can do better.  There are still 5 million children who are eligible for Medicaid or CHIP, but don’t have coverage.  Maybe they haven’t heard of the programs, or don’t know they’re eligible, or maybe they’ve applied before and were turned away.  But we need to find them now.

We’re challenging states, local governments, community-based organizations, health centers, and faith-based organizations to enroll all of the children who are eligible for CHIP or Medicaid, but do not have coverage now.   We hope you’ll take us up on that challenge.

But good health is also a matter of what you eat and how much you exercise.  It’s even a matter of where you live if you don’t have a grocery store in the neighborhood with fresh fruits and vegetables, or there aren’t safe places to go outside and play.

This brings me to the second priority, prevention.

One of our most important initiatives is ending the childhood obesity epidemic.  One in three children is overweight or obese today, which puts them at risk of a long list of serious long-term illnesses, including diabetes and heart disease.

We can’t allow this to be the first generation of children who have a shorter lifespan than their parents. That’s one reason we’re making such a significant investment in prevention.

The Recovery Act has up to $650 million to HHS to help people across the country stay healthy—the funds are part of a comprehensive prevention and wellness initiative, called Communities Putting Prevention to Work.  

This new initiative complements the First Lady’s Let’s Move campaign, by supporting  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 disease.   

And prevention isn’t limited to health care.  The budget also invests in evidence-based teen pregnancy prevention so that we apply the best knowledge to make sure kids grow up and finish their education before they become parents.

And our efforts are not limited to mothers-to-be.  We’re trying new approaches like home visiting, to help families succeed at the world’s most important job— parenting.  We’re investing in fathers—engaged dads are key to reducing poverty and providing a better future for kids.

Unfortunately we know that despite all of our good efforts, some families don’t succeed and some children end up in foster care.

Here’s where I want to mention innovation.

While we’ve made some progress reducing foster care caseloads, we know we have to do better—particularly to help our most vulnerable kids who remain in foster care for long periods of time.  We’re exploring new approaches in demonstration projects to help these most vulnerable kids. One critical feature of these—and all of our demonstrations—is a robust evaluation component.  

Another innovation we’re making is helping raise the quality of medical care across the country with health information technology.

The President's 2011 budget provides $2 billion to upgrade information technology in Medicaid programs, and when states take the right steps to upgrade their systems, the federal government will pay for 90 percent of the changes.  Funds will also support job training for nurses and pharmacy techs to IT technicians in the emerging field of health IT.

Our goals in next year’s budget—and in the work the Department is doing this year—are to promote opportunity; use what we learn through careful study and evaluation to implement the best strategies we can; and, to continue to innovate and evaluate so we can develop the best practices of tomorrow.

We know we don’t have all the answers but we’re determined to move ahead.  And, as I mentioned earlier, we can’t do this all by ourselves.  We value your partnership and we will need it to succeed with every one of the priorities I’ve just gone through.  And I think so far we’ve worked pretty effectively together.

The Recovery Act was a partnership with states which, along with a lot of other key support, provided states with the resources that would help families weather the recession.

The temporary increase in the Medicaid matching rate was one important example of our partnership. We hope Congress will enact the President’s budget proposal to extend the higher matching rate so that states will continue to get fiscal relief in the 2011 state fiscal year.  The Senate has done so and we hope this will get done soon.

The Temporary Assistance for Needy Families Emergency Fund was a great example of what states and the federal government can accomplish by working together.  

In almost every state, you are using these funds to meet rising cash assistance costs, provide short-term help to families in need, and creating subsidized jobs for parents who need them.

The House has passed an extension of the Emergency Fund through 2011 and provided $2.5 billion for 2011 so you can continue these important initiatives as the economy continues to improve.  We hope that this will soon get enacted so you can plan your efforts accordingly.

I also want to assure you that this administration is committed to ensuring that federal agencies work in partnership as well.

We know if we are going to improve early childhood education, we have to work with the Department of Education.  We know that if we are going to reduce family and chronic homelessness, it is going to take joint efforts by HUD, HHS, states, localities and others to maximize our impact on vulnerable families and individuals.

We know that for kids to succeed they need to have good nutrition—which is why we are encouraging states to marry resources from HHS and USDA to make sure that kids have healthy lunches this summer.

I am committed to making government work better by breaking down silos, so that all the right players at every level are helping to create opportunity for all.

And, we’re going to need your partnership to successfully implement health insurance reform.

Families can’t succeed if they’re worried about how they’re going to get medical care when they need it.  This is why the President set out to do what Presidents for decades have failed to do—enact health insurance reform so every American has access to health care.

The legislation President Obama signed last Tuesday brings down health care costs for American families and small businesses, ends the worst practices of insurance companies, and expands coverage to millions of Americans.

I know Ann Kohler and Cindy Mann have already given you a very comprehensive overview of how health insurance reform is going to affect Medicaid programs in the states, so I won’t go into the details again.  But I do want to clear up any misconceptions floating around about just what health reform is going to require states to do.

The bottom line is, the federal government is underwriting the expansion of Medicaid to an enormous extent.

One very important change is the provision that extends Medicaid coverage to childless adults.

Newly eligible adults will be fully funded by the federal government for the first three years.  States will receive a 100 percent match rate for newly eligible adults and will qualify for an enhanced federal match indefinitely, with the federal share never falling below 90 percent of Medicaid costs.

We are bumping up the matching rate for CHIP.

We will pay all of your costs in 2013 and 2014, for bringing Medicaid payment for primary care doctors up to Medicare levels.  We need more doctors who can make a living providing low income people with primary care.   

The health reform law also does other things to increase access to care for low-income people.  For example it increases funding for community health centers so that the number of patients who can be served will nearly double over the next five years.  

It provides funds to increase the number of primary care doctors, nurses, nurse practitioners and physician assistants in underserved areas.  Funding for both of these initiatives will be available in the next fiscal year.

Now, as difficult as it was to enact health care reform – the real work starts now.

We’re going to need your help in making the promise of health insurance reform real for people across the country.

Everyone should have access to health care coverage, and like everything we’re doing, it won’t succeed if the federal government is not a partner with the states.  We need to work together to make sure our kids have healthy futures.  We have to collaborate to promote prevention in communities across the country so we can save lives and resources. We clearly need your ideas and experience to develop the best practices of tomorrow.

And I’m looking forward to rolling up our sleeves and working alongside you to make sure that health insurance coverage is there for the American people too.

Thank you again for all your good work.  I was glad to have the opportunity to be here today.