April 6, 2010
When the conversation about reforming our health insurance system began nearly a year ago, there were some pundits who thought the days of America solving big problems were over. They wondered whether transformative legislation like Social Security and Medicare was part of a bygone era like soda fountains and five cent matinees. Last month, those pundits got a definitive answer. After decades of asking, “When are we going to fix our broken health insurance system?” – we finally have an answer: “starting now.”
The law that President Obama signed will give Americans more control of their health care. The mom who worries she’ll have to skip her next round of chemotherapy because her insurance policy puts a lifetime cap on her benefits, can stop worrying: this law makes those caps and other unfair insurance practices illegal.
The factory worker who puts off retirement because he knows his diabetes will make it impossible to get health care coverage on the individual market can retire in peace: this law will end insurance discrimination based on preexisting conditions.
The entrepreneur who’s frustrated because she wants to buy insurance but can’t find an affordable policy will finally get some relief: this law will create a new, consumer-friendly health care market where she can band together with other consumers to negotiate lower rates, just like Fortune 500 companies do.
And the parents like me who believe we need to reduce our long-term debt so that our children can have the same opportunities we had can feel confident, knowing this law doesn’t just pay for itself – it actually reduces the deficit by more than $100 billion over ten years and $1 trillion over the next ten.
Now, I want to be clear: the Affordable Care Act is not a magic pill that will cure all the problems in our health care system. It will take time for all the benefits to kick in. And if you look at the history of major social legislation, you see that there are always revisions and adjustments along the way.
But this law is the biggest expansion in health care coverage since Medicare; the biggest middle class tax cut for health care in American history; the most aggressive health care cost-cutting law we’ve ever had; and the most ambitious health care innovation legislation I’ve ever seen, all rolled into one.
The more Americans learn about this legislation, the more they’ll like it.
But our work didn’t end when President Obama put down his pen. In some ways, it’s just begun.
We have a great law. Now, we have to carry it out effectively.
To do that, we’ll need to communicate clearly with the American people. Many of our friends and neighbors still have questions about this law. That’s understandable. Given the complexity of our health care system, which makes up one sixth of our economy, it would be surprising if they didn’t. And it didn’t help that they were bombarded by nearly two hundred million dollars in ads over the last year, many of which were intentionally misleading.
For these Americans, our department will serve as a nationwide health insurance reform Help Desk. If you have questions, we’ll have answers. If you aren’t sure what to believe, we’ll have the facts.
We know that the only way this law will achieve its full potential is if Americans understand and take advantage of all the new benefits and choices that will be available to them.
So here are the facts: if you like your doctor, you can keep your doctor. If you like your health plan, you can keep your health plan.
This law builds on the health insurance system we have, and makes three key changes. First, it makes sure that every American who has an insurance policy gets real security by creating common sense rules of the road that require insurance companies to treat you fairly.
Second, it makes insurance affordable for millions of Americans by creating a new insurance marketplace and providing tax credits for those who need additional help.
Third, it starts to bring down costs for families, businesses, and governments with the broadest health care cost-cutting package ever – one that includes every serious idea for health savings that was proposed over the last year.
That’s the basic outline.
Now, one way to carry out this law would be to make all these changes immediately. But that might overwhelm our health care system. And it wouldn’t give us enough time, for example, to work with states to design the new health marketplace.
Since our goal is to strengthen the health insurance system for all Americans without disrupting it for any, we took a different approach. We’ll implement these reforms quickly, but not all at once. Instead, they’ll fit together like puzzle pieces, each one leading logically to the next.
Still, we knew we had to give some immediate relief to the millions of Americans struggling with our health care system. For many of them, there will be help right away.
For example, starting on June 15th, seniors who have hit the prescription drug donut hole will get a $250 rebate check to help them afford their medicines this year. And there is a new tax credit – available right now – to help small business owners like the man who wrote me and said: “As a small business owner, I am near the breaking point. With guaranteed annual increases at 10-15 times inflation, eventually we will go out of business or be forced to cancel insurance.”
At the same time, we’re adding new protections that will make insurance stronger for Americans who have it. That new rule ending lifetime caps on benefits takes effect this year. So does a rule preventing insurance companies from canceling your coverage when you get sick.
And the new health reform law will also make it easier for Americans to get insurance. Right now, it’s totally legal for insurance companies to refuse to cover kids who have a preexisting condition In other words, we have a health insurance system that often excludes the people – sick kids – who need it most.
Starting this fall, this practice will be outlawed. We’ll also create a temporary high risk insurance pool program that will be available to all Americans who are shut out of insurance because of their preexisting conditions. And young adults who need coverage will be able to stay on their parents’ insurance until they’re 26.
During these early years of implementation, we’ll also be working with doctors across the country to turn Medicare into a quality-driven, high-value health care purchaser. When seniors walk into a hospital or doctor’s office, they should get the best care possible each and every time. And as the world’s largest insurance program, Medicare has a lot of clout when it leads by example. History has shown that if Medicare can find smarter ways to pay for care, other insurers will copy them, and we’ll all get better results.
Under the new law, Americans will start getting more control over their health care this year. By this fall, it will be easier for seniors to get medicines, easier for families and young adults to get coverage, easier for small businesses to cover their workers, and every American who has health insurance will have more security. If you have any questions or want to see the whole list of first-year benefits, I encourage you to visit our website – healthreform.gov.
What’s going to make these 2010 reforms even more effective is that they’ll build on the significant improvements we made to health care in 2009. This is a story that a lot of people overlooked. But for example, one of the first bills President Obama signed was the CHIP Reauthorization Act. And by the end of last year, we had enrolled 2.6 million previously uninsured kids in CHIP and Medicaid.
Then we passed the Recovery Act, which was a job creation bill first, but was also one of the biggest health innovation bills in American history. Under the Recovery Act, we funded proven, local health and wellness strategies to help give families more healthy choices in their neighborhoods. We expanded Community Health Centers, which now provide high-quality primary care to 19 million Americans a year. We invested in the National Health Service Corps to strengthen our primary care workforce, especially in underserved areas. And we made a historic investment in health information technology, which helps patients fill out fewer forms and doctors deliver better care.
I’ll give you one example of the kind of impact this technology can have: yesterday, I visited Cincinnati Children’s Hospital where they’ve now gone over 1,000 days without a serious safety incident in their Neonatal Intensive Care Unit. And they say a big part of the reason why is electronic health records.
Our goal is to spread these outcomes across the entire country. And today, I’m happy to announce the latest round of these Health IT grants, which will help create 60 Health IT regional extension centers around the country. These centers are going to be like Apple Geniuses for Health IT. If your doctor wants to switch to electronic records, all they have to do is come to one of these centers and they’ll get the expert advice and technical assistance they need to get that system up and running.
When all the progress we made in 2009 is added to this law’s new reforms for 2010, you get a health care system where it’s easier to get coverage, easier to afford care, easier to find a doctor, easier to make healthy choices, and easier to access your own health information. That means a health care system where Americans are going to get a lot more health for their investment.
These changes also create a foundation for 2014 when the biggest elements of this new law kick in. That’s when the health insurance exchanges become operational and tax credits become available for individuals and families to buy insurance. This will be a huge breakthrough for health care consumers. For the first time, the question so many people write to me – “where can I find affordable insurance?” – will have an easy answer for every person in America. Instead of having to visit a dozen different websites and poring through the fine print, there will be a one-stop shop where the benefits for different plans will be clearly listed and easy to compare.
This is the new law. And as America’s Help Desk we want make sure every American knows about the benefits and choices that come out of it. So over the next few months, we’ll be reaching out directly to Americans across the country to make sure they know how to take advantage of it. For example, we’ve already begun to educate seniors about prescription drug assistance. Last week we put out a series of fact sheets that explain step-by-step how small business owners can collect their health care tax credits. And soon, we’ll put out a similar fact sheet for employers who want to take advantage of a new reinsurance program that will help them provide coverage for early retirees.
Every American should bookmark our website healthreform.gov. You can go there to read more fact sheets, get your questions answered, and watch weekly web chats where we take questions live from around the country. We’ll also be working with lots of stakeholder groups to broadcast information about the bill even more widely.
For years, Americans have struggled with a health insurance system that was opaque, unnecessarily confusing, and often overwhelming to navigate. Our goal as we implement this law is to be the opposite of that – to be as clear and transparent as possible. As soon as we know something, we’re going to tell you.
But ultimately, we recognize that actions speak louder than words. No matter how good a job we do educating Americans about the benefits for them in the bill, it won’t be much use unless we also implement those policies responsibly and effectively. As the President has said many times, we need to get this right. And as the letters I get every day make clear, we have no time to waste.
So in the week since President Obama signed this law, we’re already acting. We’ve restructured the Centers for Medicare and Medicaid Services so that it’s better prepared to take on its new responsibilities under health insurance reform. Last Friday, we began working with states to create a new high risk pool program that will help uninsured Americans with pre-existing conditions get coverage. Yesterday, we sent new guidance to Medicare Advantage plans, which includes stronger cost sharing protections for seniors. And later this week, we’ll open new Medicaid options to cover low-income adults.
Unfortunately, scam artists have been moving just as quickly. We’ve already heard reports crooks trying to capitalize on this new law by setting up 1-800 numbers and going door to door trying to sell fraudulent insurance policies. This kind of criminal activity which preys on the Americans who are most vulnerable in our health care system is outrageous. That’s why I sent letters today to State Insurance Commissioners and Attorney Generals asking them to investigate and prosecute these scams.
This kind of communication and collaboration will be the key to making this law work for Americans. Over the next few years, we’ll be working with providers and employers, consumers and seniors to get this law right.
Many of the key reforms will be carried out by the states. As a former Insurance Commissioner, I know how tough and effective state regulators can be. That’s why states will have the option to oversee the development of the insurance exchanges, regulations, and consumer protections. The law provides resources and assistance to states, but when it comes to the specifics, we assume that the people on the ground know best.
As a former Governor, I also understand the budget challenges that states face. And what I’ve said over and over again is that this is actually a very state friendly bill.
It’s true that part of the law makes health care coverage a partnership between the states and the federal government. That expansion starts in 2014. For the following three years, the federal government picks up the entire bill. After that, the states start paying up a share, which rises to ten percent by 2020. So there will be some new costs.
But those costs are balanced by new benefits, including less spending on uncompensated care, savings from reduced insurance paperwork, more resources to cover children, and more money to crack down on fraud and abuse. And that doesn’t even count all the people who will get better care, live healthier lives, and be more productive workers. As a Governor, I can say unequivocally that if you had offered my state this deal, I would have taken it in a heartbeat.
At HHS, we’ll work closely with the states as the lead federal department for implementing this law. So in closing today, I want to share a few of my operating principles for making sure the full benefits of this law reach the American people.
First, as I said earlier, we will be transparent. That doesn’t just mean sharing what we know. It also means making it as convenient as possible for the American people to access that information. For example, today, we’re announcing the release of what we call our Medicare dashboard. This is an online tool that will make it much easier for Americans to search and sort aggregate Medicare data with full protections on patient privacy. Today, we’re making available Medicare’s inpatient hospital spending data, which you’ll be able to sort by state, condition, and hospital. But this is just the first step of many we’ll be taking to give consumers, purchasers and providers the health information they need to make smarter choices.
Second, we’ll make every dollar count. Eliminating waste in our health care system is a key part of this law. It’s also a principle we’re going to apply to every step of implementation. One of the ways we’ll save money is by depending heavily on people and systems that are already in place. Our department already has great talent, resources, and knowledge of the health care system. As we move forward, we’re going to rely on these resources as much as possible as we fulfill our new responsibilities under this law.
Third and most important, we will never lose sight of why we pursued this legislation in the first place, fought so hard for it, and are celebrating it as such a historic accomplishment. Over the last year, I’ve read letter after letter from families and small business owners who feel powerless in the health insurance system we have.
Their premiums go up by 30 or 40 or 50 percent every year and they don’t understand why. They’d argue with their insurance company, but they’re afraid their coverage will get cancelled. They’d switch to another plan, but many of them have a preexisting condition and know they couldn’t get another policy. Even Americans who get good insurance through their job worry. They see more and more of their paycheck being eaten up by rising premiums every year, and they know how quickly the partial security they do have could disappear if they switched jobs or retired.
Our goal is to put these Americans back in charge of their health care. We will provide information and education if it’s needed; set basic guidelines that will help foster a competitive insurance market; serve as an umpire to make sure insurance companies treat Americans fairly; and provide targeted resources to help empower consumers. But ultimately, this isn’t about us. It’s about you. It’s about giving Americans more choices, more security, and more control.
There will be bumps along the way. There will be twists and turns. It will not be easy.
But after decades of standing still, we are finally moving forward.