American Academy of Pediatrics Legislative Conference
March 14, 2011
Remarks as prepared for delivery
Good afternoon. I want to thank Marion for that nice introduction. It’s great to be here with you today.
I understand that tomorrow you’ll be visiting the Hill. Obviously, a lot of the discussion in Congress right now is about finding savings in our budget. And that’s the way it should be. We need to make tough choices, which is why President Obama has proposed a budget that would bring discretionary spending to the lowest share of our economy since Dwight Eisenhower was president and I was getting checkups from my pediatrician.
But one thing President Obama has made clear is that even as we make difficult cuts today, we cannot afford to sacrifice the key investments that will help us continue to lead the world tomorrow. And there’s no better investment in our future than the health of our children.
That’s why, from President Obama’s first days in office, this Administration has put an unprecedented focus on improving children’s health. And we’ve had no better partners than America’s pediatricians.
Just look at what we accomplished in the last two years. We had a dangerous flu, H1N1, which we had never seen before. It was especially deadly for children. And there were some dire predictions.
But we launched a historic public education and vaccination campaign that brought together the federal government, state and local governments, scientists, health care providers, the public health community, schools, employers, even Elmo.
The American Academy of Pediatrics played a huge role, not just administering the vaccine but also leading our efforts to educate people about how safe and effective it was. Together, we were able to avoid the worst forecasts for flu season.
You also helped pass the reauthorization of CHIP which made health insurance available to four million additional children.
And today, partly due to that law, the share of children without health insurance is lower than ever before.
But we didn’t stop there. We knew that there were five million children without health insurance who were already eligible for coverage through CHIP or Medicaid. We didn’t need to pass a law to get them health insurance. We didn’t need to create a new program. We just needed to find them and sign them up.
So in 2009, I issued the Connecting Children to Coverage Challenge, calling on everyone from Governors to high school coaches to work with us to enroll these kids.
And one of the first groups to come forward and sign on was the American Academy of Pediatrics. Now, we’re working together towards the day when no parent has to stop and ask “can I afford this?” before they bring their child in for a check-up.
We’ve also worked together to turn the tide on the childhood obesity epidemic. Through the First Lady’s Let’s Move campaign, she’s enlisting partners around the country to make it easier for parents and children to make healthy choices. And it’s no surprise that once again, pediatricians were one of the first groups to volunteer their help.
I remember one time listening to Judith Palfrey talk about childhood obesity from a pediatrician’s perspective. And she explained in very vivid terms that childhood obesity did not just mean an increased risk of chronic disease later in life.
She explained how it was affecting our children right now, even at very young ages. She explained how it can affect the way they move, how it can increase their chances of asthma and other respiratory diseases, how it can increase their risk of bone and joint problems.
So pediatricians have understood this danger for a long time. And when the First Lady asked you to join her campaign, there was once again no surprise that pediatricians stepped up and pledged to make a body mass index screening a part of every childhood checkup. And now, thanks to you, families across the country are starting to understand that this is a medical issue just as serious as a virus or broken bone.
Working together over the last two years, we’ve taken some incredible steps to improve the health of our children. But the biggest step of all was passing the health care law, the Affordable Care Act, last March.
No one had a closer view of the gaps in our health insurance system than you. You saw it when your patients didn’t refill their prescriptions because they couldn’t afford to. You saw it when families skipped vaccinations or check-ups because their co-pays were too high.
When I think of the old health insurance system, I think of the mother who came up to me and told me that her son had gotten a liver transplant when he was ten months old. And that she had been afraid ever since that he would never be able to get health coverage once he moved off her plan.
Or I think of the pediatric emergency doctor from Virginia who wrote that she was sometimes reluctant to enter her patients’ health information into their electronic health record because she feared that it could later be used by insurance companies to deny them coverage.
When sick children can’t get care and dedicated doctors can’t do their jobs, the health insurance system is broken.
That’s why we worked together to help pass a law that has ensured that no child will ever again be denied health insurance because they were born with a disability or have asthma or diabetes.
But that’s not all. Thanks to the law, we’re investing in proven home visitation programs, where evidence has shown that a small investment can help parents develop skills that benefit their children for years to come.
And we’re reducing the barriers to preventive care. Now, all children in new health plans will get free access to the gold standard of well-baby and well-child exams, developmental screenings, and immunizations recommended by the American Academy of Pediatrics.
When you add all these changes up, it’s one of the most ambitious children’s health agendas in our country’s history. And we couldn’t have done it without you.
It’s one thing for me to deliver these messages. I do it all the time. I travel around the country and I talk about the importance of vaccinations. I talk about our opportunity to get more kids covered by health insurance. I talk about the value of eating a healthier diet and getting more exercise. I talk about how doctors and families, not insurance companies, should be making health care decisions.
But there is no one parents trust more than you. There’s a reason why the first phone number parents memorize is their pediatrician’s. So when Americans hear these messages from you, it makes an enormous difference. Other voices can get lost in the buzz of debate. Yours break through.
So today, I want to say thank you, not just for the care you provide to our children every day, but for the advocacy you pursue on their behalf.
But there is also more work to be done. There are still too many children who don’t have health insurance simply because they don’t know it’s available to them or the process to enroll is too burdensome. There are still too many neighborhoods where it takes 30 minutes to walk to the nearest supermarket to buy fresh fruits and vegetables, but only 30 seconds to get to the corner store and buy a bag of chips. There are still too many families who still don’t know about the new benefits available to them under the health care law. We need to keep moving forward in all of these areas.
But today, I also want to talk to you about another area where we can work together: reforming the way we pay for and deliver care in this country.
You know as well as anyone that even after our children make it into a doctor’s office or health center or hospital, they still face obstacles to getting the right care.
Every year, nearly two million Americans develop a health care-associated infection – not an infection you bring to the hospital, but one you get once you’re already there. At the same time, almost a third of our health care spending – nearly $700 billion a year – goes to pay for services that may not improve people’s health.
You face obstacles as provider too. You want to deliver the best care. But the way we pay for care rewards quantity, not quality. And there’s often no payment at all for the conversations you have with patients or other doctors that are so important to doing your jobs.
You spend too little time with your patients and too much doing paperwork. Too often, your patient’s lab results disappear, or their medication list is lost, or their medical history is incomplete.
And even though we understand better every year how important primary care is, especially for children, primary care providers still make far less than specialists. The result is that too many medical students look at this math and decide not to go into primary care, even if that’s what they’ve always dreamed of doing.
We need to change this system so patients can get the right care, doctors and nurses can do their jobs, and we can bring down the health care costs that are burdening families, businesses, and government.
You know this. Pediatricians haven’t just supported the medical home model. You invented it. You know that when health care providers work together and focus on the patient’s needs that it’s possible to deliver care that improves outcomes, reduces costs, and increases provider satisfaction.
Under President Obama, we’re committed to promoting this kind of high-quality health care across the country. To do that, we hired a pediatrician, one of the country’s most respected health care quality experts, Dr. Don Berwick, to run Medicare and Medicaid.
And we gave him a great platform to build on in the health care law, which calls for a series of transformative payment and delivery system reforms, and the creation of a new, first-of-its-kind Innovation Center in Medicare and Medicaid that will explore additional models for delivering higher-quality, lower-cost care.
Some of the first projects that Innovation Center is supporting are efforts that build on the medical home model.
For example, it’s backing a multi-payer Advanced Primary Care Practice Demonstration, an initiative in which Medicare will join Medicaid and private insurers in state-based efforts to improve the delivery of primary care and lower health care costs.
It’s also working with Medicaid to support the Health Home State Plan Option which allows Medicaid beneficiaries with at least two chronic conditions to designate a provider as a “health home” to help coordinate treatments.
A third project will look at how we can provide patient-centered, coordinated care to treat low-income patients at as many as 500 Federally Qualified Health Centers.
The law also includes new support to allow health care providers to form Accountable Care Organizations. If they can find ways to delivery quality care at less than the average cost – whether it’s by helping patients manage their chronic conditions or coordinating care to avoid unnecessary treatments – they’ll get a share of the savings.
We need you to participate in these models. They’re how we learn what works and what doesn’t. The transition may not always be easy. There will be bumps along the way. But in traveling the country, I’ve rarely talked to a doctor or nurse who works in a well-designed medical home and says, “I’d really like to go back to the old system of fragmented care and no communication.”
So we need your help. But we also understand that you need more support from us. That’s why the health care law will increase Medicaid reimbursements for primary care. It’s why we’re investing in the National Health Service Corps and other programs to strengthen our primary care workforce. And it’s why we’ve created dozens of regional extension centers across the country to help small health care practices adopt electronic health records and qualify for new incentive payments.
Over the last two years, with your help, we’ve undertaken perhaps the most ambitious children’s health agenda in American history. Now, we need to work together to make the most of it.