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National Association of Counties Annual Conference

Ft. Worth, Texas
July 22, 2013

Good afternoon.  Thank you, Linda, for that introduction, and congratulations on your new position as President of NACO. Thank you, Chris Rodgers, for your service as past president. And I want to thank you all for being here and for your service to your counties and our country.  

As a former governor and recovering state legislator, getting the opportunity to speak with local leaders like you feels like home.  I’ve seen firsthand the incredible work you do. You’re on the frontlines growing local economies and providing critical public safety and infrastructure.  You help communities recover from natural disasters and protect the public’s health.

And you’re doing all of that on what can often feel like an impossibly tight budget. It’s a challenge that’s shared by just about everyone here today—whether you’re from Los Angeles County or Linn County, Iowa.

Today I’d like to talk about how our Department is working with you to meet the challenges, but also seize the opportunities facing your counties.

Many of you are engaged already in building healthier communities—from creating bike paths and running trails to providing fresh fruits and vegetables in food deserts.

And I want to thank you for your critical partnership with our amazing First Lady, Michelle Obama, on the Let’s Move! Initiative to reverse the trends of childhood obesity.

I remember being in Philadelphia last year to help launch the next chapter of Let’s Move! Cities, Towns, and Counties, which provides local leaders the support to make the healthy choice the easy choice for children and families in your counties. And it’s wonderful to see how many of you answered the call to action.

In just one year, more than 300 communities have joined the effort to help more than 56 million Americans live in a Let’s Move! City, Town, or County. Two weeks ago at the White House, the First Lady joined local officials from across the country to celebrate this incredible achievement. But she also challenged all of us to redouble on our efforts.

So I encourage all of you to join our efforts if you haven’t already – and bring along your colleagues in neighboring communities. Together we can end childhood obesity and make our communities healthier for generations to come.

That’s how we build a stronger, more prosperous future – and move our country from one focused on sickness and disease to one based on wellness. And it builds on the Department’s investments in other community prevention efforts.

For example, we have a first-of-its-kind National Prevention Strategy to engage public and private partners to build healthy and safe communities, empower healthy choices, expand preventive services, and eliminate health disparities.

Like you, we believe it’s better to keep people healthy than to wait and pay for treating their illness. And each day, you see the toll that poor health takes on your counties. 

You see it in emergency rooms crowded with people whose costly conditions could have been prevented. You see it in local businesses losing productivity because their workers are out with chronic illnesses.  You see it in community hospitals strained by the cost of uncompensated care. And you see it in jails packed with people who were unable to get the mental health care they needed.

You understand the sweeping costs that poor health can create.  But you also understand the across-the-board benefits that come from improving health in your communities. I know many of you are doing terrific work at the local level—and we’re learning from your best practices. 

But there’s a limit to how much we can improve the health of our communities until we also expand access to quality, affordable health insurance.  And that’s exactly what the Affordable Care Act is already doing and will continue to do.

In every county in America—from small towns and rural communities to big cities—people are seeing the benefits of the health care law.  For the 85% of Americans who already have insurance—the first thing they should know is that the health care law is making that coverage stronger.          

More than 3 million young people have gained coverage under their parents’ health plans—giving them the freedom to pursue their dreams. 

Seventy-one million adults with private insurance can now get essential preventive care at no out-of-pocket cost—meaning they no longer have to put off a potentially life-saving mammogram because they’re worried about paying their bills.  

In 2012 alone, nearly 3.5 million seniors on Medicare saved an average of more than $706 each on their prescriptions—enough to cover two or three months worth of groceries.     

We’re also training more doctors and nurses and expanding community health centers in urban and rural counties with too few medical providers.

And because of the health care law and prior legislation that helps put mental health on a par with physical health, 62 million Americans will soon gain access to mental health and substance use disorder benefits and federal parity protections. 

I know this is a critical issue for many of you. We know that more than 60% of Americans with mental illness do not receive the help they need—and too many are in county jail or living under a bridge instead of getting treatment. Expanding access to new services and coverage will make a difference to show treatment works and recovery is real.

But a critical part of the law is still to come.  So the second thing to know is that for the 15% percent of Americans who don’t have coverage at all, or for Americans who buy their own insurance now but aren’t happy with it, they’ll have better options come this fall.

First, a new online Health Insurance Marketplace will be open in every state through When open enrollment begins October 1st, these Marketplaces will give families and small business owners in your county a whole new way to find coverage that fits their budget—and that starts as soon as January 2014.

Just like many employer-sponsored plans, all plans in the Marketplaces will cover a set of essential benefits, including doctor visits, prescription drugs, and mental health services.  Discrimination based on gender or pre-existing conditions, like diabetes or cancer, will be outlawed.  And many individuals, families, and small businesses will qualify for a break on the costs of their premiums.

And because of the Marketplaces, insurance companies will have to compete for business based on price and service—not lock out, dump out, or price out of the market anyone who might get sick. Those days are over.

Just last week, New York announced that premiums for individuals enrolling through the state’s Marketplace could be 50 percent less costly than they generally are today.  Eleven other states from California to Vermont recently announced rates for plans offered through the Marketplace that will also be more affordable and coverage of higher quality. 

As October 1st approaches, your constituents looking for coverage will find more competition and better prices to choose from.

The second way the Affordable Care Act is covering more people is by giving each state new opportunities to expand its Medicaid program.

No one understands the enormous benefits of expanded coverage better than county leaders like you. Medicaid expansion would reduce the burden of uncompensated care.  It would inject significant resources into your local economies and local hospitals.  It would free up county dollars that could be used on other priority areas. 

And that’s in addition to the many families you represent who would finally be able to enjoy the daily security of health coverage.

As a former governor, I know the best part for states is the deal we’re offering: The federal government will cover 100% of the costs of Medicaid expansion for three years, and at least 90% after that.  And we’ve been pleased to see governors from across the country and across the political spectrum seize this opportunity. 

But if states do not expand their Medicaid programs, a lot of people in your counties could fall through the cracks, with no support and no source of affordable health coverage at all. We can’t let that happen.

That’s why your perspective is a critical part of this conversation.  You’re pragmatic leaders. You have to be. You don’t have the luxury of passing the buck and playing politics when it comes to your budgets.

I can tell you, some of that local government pragmatism would be a welcome contribution to the national debate.  That’s because we know greater access to care could make an enormous difference to families in your counties.  And when families get good coverage, the results ripple through our communities.

But here’s the key point: Just because these new coverage options may be available doesn’t guarantee that people will even know about them, let alone take advantage of them.

It is absolutely critical that we reach out to the very people in your communities who stand to benefit the most from this expansion, and get them ready to sign up for coverage on October 1st

A big share of the uninsured is young and healthy. If you have young adult children like I do, you know that getting health insurance is not always their first priority. I sometimes don’t know what their first priority is, but it certainly isn’t insurance.

But we also know there are people who have been uninsured or underinsured for so long that they simply don’t believe that affordable coverage will ever be within reach.

You can help reach them right now by visiting to sign up for updates that you can share with your constituents and colleagues, family, friends, and neighbors.

This isn’t your typical government website—it’s much easier to use and understand. There’s a live web chat feature to help answer your questions—just like what you see when you’re shopping online.  And if you don’t have access to a computer, there’s a 24/7 customer call center ready to answer your questions in 150 languages.

And we’re doing everything we can to help spread the word.  We’re partnering with your local libraries and community health centers to help people sign up and enroll in October.  We’re supporting efforts to hire people who will work in many of your communities to educate your friends and neighbors about their options.

But no one is better at reaching your constituents than you are.  And I’d like to take a moment to thank NACO Executive Director Matt Chase for his leadership to establish a partnership between NACO and HHS to strengthen enrollment efforts in your counties.

Those constituents who are used to stopping you in the grocery store to ask questions about fixing that pothole or developing that park— will start asking questions about finding insurance in the Marketplace or through Medicaid.  And you’ll have the answers they need.

Connecting them with quality health coverage may be the single best thing you can do to advance the health of your counties—and that’s true whether your county has 1,000 people or 10 million. 

I’ve traveled the country sharing the same message.  Just last week I was in Orlando talking to the mayor and local leaders.  This morning I spoke with county officials in Dallas. We know people need a lot of information. They just want to know where to go to find it.  And you can make all the difference.

So I encourage you to engage with local leadership in the health, business, and faith communities. Host educational events at community centers this summer and enrollment events in October.  Work with shelters, job-training programs, law enforcement, and local media. 

If we’re going to build a healthier, more prosperous America, it’s got to happen state by state, county by county, and neighborhood by neighborhood. 

And it’ll require the kind leadership that you provide each day in tackling the challenges—and seizing the incredible opportunities—facing our counties and our country.

Thank you all for what you do.

I look forward to being your partner in the critical months and years ahead.

Thank you.