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City of San Antonio Metropolitan Health District Event

San Antonio, TX
August 8, 2013

Good afternoon.  Thank you, Dr. Schlenker, for that introduction.  It’s a pleasure to be here with so many San Antonians who are all here today for one reason: you care about the future of this city.

Cities like San Antonio face some tough challenges.  You need to keep your local economy thriving.  You need to ensure that your streets are kept safe.  You need to promote job growth and strengthen schools to create a more competitive workforce.  And you need to do all of that on a tight budget.

Today I want to talk about a common thread connecting all of the biggest challenges that San Antonio and other cities across the country face: health.

Health is so important to everything that happens in our cities and towns.  Healthier communities lead to healthier students and more productive workers.  Companies now look at cities’ health profiles before deciding where to open a new branch.

Here in San Antonio, tremendous progress is being made on health—just last week, we heard that the obesity rate here in Bexar County dropped by 20% between 2010 and 2012.

But despite the excellent work being done here, too many cities have dangerously high obesity, smoking, and chronic disease rates.  Too many people are living too sick and dying too soon.

At the same time, cities have been squeezed by the burden of high health care costs.  And when costs are high and care is unaffordable, the consequences are felt all over our cities.  So no matter what your top priorities are for building San Antonio’s future, each of you has an interest in fostering a health care system that contains costs and improves health.

And those goals are exactly why we passed the Affordable Care Act.

In every state right now, people are seeing the benefits of the health care law.  For the 77% of Texans who already have insurance—the first thing to know is that the law is only making that coverage stronger.

More than 350,000 Texans under twenty-six have gained coverage on their parents’ health plan—giving them the freedom to pursue their dreams. 

More than 5 million privately insured Texans 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 the cost.

Last year alone, more than 200,000 Texas seniors on Medicare saved an average of $680 each on their prescriptions—enough to cover several months of groceries.

But a critical part of the law is still to come. 

So the second thing to know is that for the 23% of Texans who don’t have coverage, or for those who buy their own coverage but aren’t happy with it, they’ll have better options coming their way this fall.

First, a new online Health Insurance Marketplace will soon open for business in Texas and every other state through HealthCare.gov. When enrollment begins on October 1st, this Marketplace will give families and small business owners a whole new way to find coverage that fits their budget.

Every plan in the Marketplace must cover a set of essential benefits, including doctor visits, prescriptions, and mental health services.  Discrimination based on gender or pre-existing conditions, like diabetes or cancer, will be outlawed.  And as many as 90% of Texans buying coverage in the Marketplace will qualify for significant breaks on the costs of their monthly premiums.

For a healthy 21-year-old man earning $17,000 a year here in San Antonio, a plan today might cost him $111 each month.  But next year he can get the same kind of coverage for only $55 each month.  A healthy 30-year-old woman earning the same amount who might pay $183 per month today will be able to get a more generous plan for under $55.  A 60-year-old man who earns $45,000 a year who might pay a monthly premium of $568 will be able to get that same type of plan for under $356 next year.  For working Texans of all ages, those savings could be a lifeline.

Thanks to the Marketplace, insurance companies will now have to compete for business the way all companies do—by offering the best products at the lowest price.  We’re moving past the days when insurers could just lock out, dump out, or price out anyone who might get sick.

We’ve already heard some great news from many states about what that change will look like for American families.  States across the country have begun to announce premium rates that will be significantly more affordable than previously estimated.

When October 1st arrives, Texans looking for coverage will find greater competition and transparency, better prices, and higher quality options to choose from.

The second way the health care law is covering more people is by giving each state an opportunity to expand its Medicaid program.

Medicaid expansion would reduce the burden of uncompensated care by billions of dollars nationwide—care that right now is paid for mostly by your local property taxes.  It would inject significant resources into your hospitals and your local economy— nearly $100 billion in federal funds to cover newly eligible adults over the next decade.  It would free up state dollars that can be used on other priority areas.  And it would create 300,000 new jobs here in Texas.

And that’s in addition to 1.5 million Texans who would finally be able to enjoy the daily security of reliable 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 expansion for three years, and at least 90% after that.  And we’ve been pleased to see governors and state legislatures from across the country and across the political spectrum seize this opportunity.

But if Texas doesn’t expand its Medicaid program, a lot of your neighbors could fall through the cracks.  And in the state with highest rate of uninsured citizens in the nation, a failure to act could be devastating.  All those families making anywhere between about $2,800 and $23,300 a year—that’s 12% to 99% of the federal poverty level—would be left in the dark with no support, and no source of affordable health coverage.  So would all adults without children—that includes young people just starting out on their own, and older couples that haven’t reached Medicare eligibility. 

So expanding Medicaid isn’t just the right thing to do from a health standpoint or a fiscal responsibility standpoint.  It’s also the right thing to do for all those Texas families who are one illness or injury away from losing everything they’ve worked so hard for.  There’s no deadline for states to choose to expand their Medicaid programs—that door is staying open.  And we need to make sure the voices of San Antonians are heard in this discussion. 

But here’s the key point on expanding coverage: just because new options may be available doesn’t guarantee that people will know about them.

It’s critical that we reach out to those Texans who stand to benefit the most from new affordable insurance options, and get them ready to sign up for coverage on October 1st

This isn’t about politics, ideology, or winners and losers.  It’s about making sure that people know about the opportunities available to them—in many cases for the first time in their lives.

About 40% of the uninsured population here in Texas is young.  If you have young adult children like I do, you know that getting health insurance isn’t always their first priority.  I sometimes don’t know what their first priority is, but it certainly isn’t insurance.

But then there’s a young man who recently shared his story with us—a 24-year-old bartender from Philadelphia.  His story could be any other young person’s story here in Texas.  He’s an uncle, and a father-figure to his sister’s children.  But he’s also one of the millions of young people who can’t afford health insurance.

Like a lot of people, he never thought much about health insurance—until something went wrong.  He hurt his foot and thought it was broken.  But he didn’t go see a doctor because he couldn’t afford it.

Today that young man is one of the millions of Americans looking forward to new coverage options this fall.  Everybody here probably knows someone like that—a family member or friend who just wants to get a little peace of mind when it comes to their health.

We also know there are people of all ages who have been uninsured or underinsured for so long that they simply don’t believe that affordable coverage will ever be within reach. They’re busy thinking about work or school—not about health insurance.  You can let them know that on October 1st, we’ll be ready to flip the switch that finally offers them the security they need.

To get ready for October, everyone can visit HealthCare.gov—or our Spanish-language site, CuidadoDeSalud.gov—to sign up for updates and create a personal account—including a username and password—which is the first step to enrollment in the Marketplace. 

HealthCare.gov isn’t your typical government website—it’s much easier to use and understand.  For many people, enrolling will be a quick process they can complete on their own.  For others who may want more assistance, we have great resources available to you.

There’s a live web chat feature to help answer your questions—just like what you see when you’re shopping online.  And for those who prefer the phone to the computer, there’s a 24/7 customer call center ready to answer your questions in 150 languages.

Shopping for health insurance is serious business.  Just like when you shop for a car, you do your research and figure out what fits your needs and your budget.  HealthCare.gov will make that process easier and more transparent for millions of Americans. And we’ll be ready for whatever comes up—we’ll be testing and retesting our systems, monitoring feedback, and responding appropriately.

To help get the word out, we’re partnering with trusted resources like local libraries and community health centers to educate people and get them ready to enroll.  We’re supporting efforts to hire people who will work right here in Texas to help in that effort as well.

And throughout the open enrollment period that runs from October to the end of March, we’ll be working around the clock to make sure Americans know about their options.

But no one is better at reaching San Antonians than you are.  And connecting them with affordable health insurance may be the single best thing you can do to improve quality of life in this great city. 

We knew all along that Washington couldn’t do this alone—but that was never the plan. The plan was always to bring together community members who care—local health care providers, faith leaders, community groups, business leaders, and individuals of all stripes—to make sure that their neighbors know about the opportunity in store for them in October.

If we’re going to build a healthier, more prosperous America, it’s got to happen state by state, city by city, and voice by voice.  The key to that work is you—leaders and concerned citizens ready to take on these challenges, seize these opportunities, and build a big, bright future for San Antonio.

Thank you.