SEIU Nurse Leadership Conference
October 18, 2011
Thank you, Dr. Lewis. And thank you all for everything you do.
Like so many Americans, my family and I owe a personal debt to nurses. My mom spent the last month of her life at three different hospitals. And what we quickly discovered was that at every hospital, the person we needed to talk to was the nurse. That was the person who understood the treatment plan. That was the person who actually talked to my mom and knew how she was doing. And that was the person who was willing to talk to us and answer our questions. If it weren’t for those nurses, I don’t know how we would have made it through that month.
Nurses go above and beyond the call of duty. That’s what you do. And not just for your own patients. Over the years, America’s nurses have also been our most passionate and persuasive advocates for health reforms that benefit all Americans. It’s why nurses supported Medicare long before it had the votes to pass Congress. And it’s why nurses never wavered in your support for the most important health care law since Medicare, the Affordable Care Act.
The history of improvements to the American health care system is a history of nurses leading the way. And I’m glad to be with you this morning for this summit because America needs your leadership again. Over the next few years, we’ll face a pivotal choice about the future of American health care. And you can play a big role in making sure we choose wisely.
On the one hand, the health care law you helped pass is already showing us that a better health care system is possible. In the last month and a half alone, we’ve learned that more than a million young people now have health insurance because of a reform that allows them to stay on their parents’ plan. We heard that more than 19 million Medicare beneficiaries have now gotten at least one free preventive service like a cancer or diabetes screening thanks to the law. And we found out that the National Health Service Corps, which places primary care providers including nurse practitioners and nurse midwives in underserved areas, has now reached more than 10,000 members – nearly three times as many as when President Obama took office – thanks in large part to the health care law.
That all happened in the last month and a half. And that’s just the start.
Thanks to the health care law, we have a new Patient’s Bill of Rights that has ended many of the worst abuses of the insurance industry. The lifetime caps on benefits that often meant your patients lost their coverage when they got sick are now banned. So is the practice of insurance companies canceling people’s coverage because of an accidental mistake in their paperwork.
Some of you may remember hearing about how the nation’s largest insurance company was using a computer program to search the forms of anyone diagnosed with breast cancer, looking for an excuse to cancel their coverage. Now, this outrageous practice is gone for good.
Thanks to the law, insurers are also prohibited from denying kids coverage because of their pre-existing conditions. Last year I met a mom in Philadelphia whose young son has a rare bleeding disorder that costs $30,000 a month to treat. When the mom lost her job, every insurer in the area turned them down. Now, she and countless other parents around the country don’t have to worry about that happening.
And we’re not stopping there. By 2014, we’re going to end discrimination against pre-existing conditions for all Americans. That means your patients will no longer see their applications denied because they have high blood pressure or gave birth by c-section or are a victim of domestic violence. Instead, we’re introducing a novel idea: you’re not allowed to lock the people who need health insurance the most out of the market.
And in 2014, it will also be illegal to charge women more for health insurance just because they’re women. Or as I like to put it, being a woman will no longer be a pre-existing condition!
For those with the fewest resources, we’re expanding Medicaid. And we’ll fix the broken market for Americans who buy their own health coverage by allowing them to choose from the same plans as Members of Congress. Eventually, more than 30 million previously uninsured Americans will get health insurance.
Think about all the patients you’ve had over the years who have gone without the treatments or medicines they need because they were uninsured or underinsured. Think of all the hours you and your colleagues have spent arguing with insurance company bureaucrats that you could have spent with your patients. The health care law means families can spend less time worrying about how to pay their health care bills and more time with you. And when I talk to people around the country, there’s nothing they want more.
But the health care law also recognizes that insurance isn’t the only barrier to care. There are too many parts of America today where people are going without checkups, preventive screenings, vaccines, and other care simply because there is no one to see them. Altogether, one in five Americans lives in an area with a shortage of primary care providers.
So through the health care law, we’re investing in America’s healthcare workforce. As I mentioned earlier, we’ve expanded the National Health Service Corps, whose members now serve about seven million more patients across the country than they did when President Obama took office.
And we’re making special investments in our nursing workforce. We know that the kind of care we’re learning works best – care that is coordinated, that emphasizes prevention, that focuses on the patients’ needs – is the kind of care nurses provide every day. So through the health care law, we’re making investments to educate more nursing professors, help more minority students fulfill their nursing dreams, and create more nurse-managed health clinics.
And we’re also making it easier for Americans to get preventive care. How many of you have had a patient show up at your hospital with a condition that could have been avoided if they got the right preventive care? It happens far too often.
So we’ve now required insurers to cover recommended preventive services like mammograms and other cancer screenings at no additional cost for most consumers. It’s simply not right for someone to show up in one of your emergency rooms needing a foot amputation because they couldn’t afford the co-pay for a diabetes screening. And the law will make sure that doesn’t happen anymore.
The law is strengthening coverage for seniors too. Medicare beneficiaries now have access to free preventive care. And we’re also providing relief to the seniors with the highest medication costs with a 50 percent discount on brand name drugs for all those in the prescription drug coverage gap. At a time when one in four seniors say they’ve skipped a prescription or cut their pills in half because they can’t afford them, this relief can make all the difference.
The health care law is working. And those dire predictions some people made about the law? Remember how they said it was going to destroy Medicare and ruin the Medicare Advantage program? Well, earlier this month we announced that for the second year in a row since the law was passed, Medicare Advantage premiums are actually going down – even as Americans enjoy better benefits.
For Americans from all walks of life and of all ages, the health care law has meant better health, better care, and lower costs. These are improvements we spent decades fighting for. And the law will only make a bigger difference in Americans’ lives as we go forward.
But as you know, the law’s opponents here in Washington have proposed a very different direction for our health care system. They want to start by rolling back every single one of these new benefits. They want to cut investments in the nursing workforce. They want to raise the price of preventive care. They want to bring back higher insurance rates for women. And they want to tell insurers they can slam the door on that mom in Philadelphia once again.
But that’s just the start. They don’t just want to take back the new investments in Medicaid. They also want to slash the program in half over the next two decades. And let’s be clear about what that means. Two thirds of Medicaid spending is on seniors and people with disabilities, mostly to cover long-term care, which Medicare doesn’t pay for. Another 20 percent is on children’s health care. And most of the rest is on moms and pregnant women. So if you’re going to cut Medicaid in half, you’re going to be kicking seniors out of their nursing homes. And you’re going to be cutting care for moms and kids.
When it comes to Medicare, they want to take an even more extreme approach. They don’t just want to raise prices for preventive care and seniors’ medications. They want to do away with guaranteed Medicare benefits altogether and replace them with a voucher seniors can use to negotiate with insurance companies. For 45 years, Medicare has been a sacred promise to Americans that you won’t have to worry about health care in your later years. The law’s opponents want to tear that promise up and replace it with what is essentially a coupon.
In other words, they don’t just want to undo the progress of the last two years. They want to undo the progress of the last 50 years. Why? Their justification for these extreme cuts to Medicare and Medicaid is that the federal government’s health spending is growing at an unsustainable rate.
That’s true. But rising costs are not a unique feature of Medicare and Medicaid. In fact, private insurance costs are rising even faster. That’s because what’s really going up is the underlying cost of care. So slashing Medicare and Medicaid would harm the most vulnerable Americans while doing nothing to actually address what’s actually driving costs up.
President Obama and the Affordable Care Act have a better approach. We know that there are health systems around the country that have figured out how to spend their dollars more wisely by emphasizing prevention, helping patients manage their chronic conditions, and using electronic health records to coordinate treatment.
So instead of simply making arbitrary cuts, the President’s plan says, “Let’s bring down costs by doing what these leading hospitals are doing: improving care.” If a health system is reducing unnecessary hospital readmissions by having nurses coordinate follow-up care, let’s help that model spread. If a hospital has eliminated certain kinds of medical errors with a surgical checklist, let’s learn from them. And by the way, when we talk about reducing medical harm, we’re not just talking about patients. Today, a nurse in Maine is more likely to miss a day of work because of injury than a logger in Maine. That’s unacceptable, and we’re working to change that.
Nurses can play a key role in these efforts to improve care. After all, nurses have always been much more than healers. People remember Florence Nightingale as the “lady with the lamp,” but they often forget that she was also a statistician and one of the first people to think rigorously about reducing health care infections. Linda Richards is known as the first trained American nurse, but it’s not always mentioned that she also developed one of our nation’s first health record systems. Dorothea Dix is famous for providing compassionate care to Union and Confederate soldiers alike during the Civil War, but she also helped transform the way we treat mental illness.
We need to continue down the trail blazed by these pioneers and improve American health care, not go backward by undoing 45 years of progress. And the best way we can make sure we keep moving forward is by ensuring Americans know exactly what’s at stake. That’s where you come in. Nurses are our most trusted and effective health communicators. When you talk, Americans listen. And that means you can play a powerful role in explaining how much we potentially have to gain – and lose – in this debate.
In the next few years, our nation is going to face an important choice. We can choose to expand access to health coverage or we can choose to restrict it. We can choose to strengthen Medicare or we can choose to force seniors to spend their final years negotiating with private insurance companies. We can choose to invest in our nursing workforce or we can make dramatic cuts to Medicaid that will force hospitals that are already understaffed to lay more nurses off.
The stakes are high. But if history has taught us anything, it’s that nurses usually prevail in the end. If we can fight through the misinformation and get Americans the facts, I’m confident our country will choose to keep moving forward. And I look forward to working with you to help make that happen.