National Conference of State Legislatures Health Summit
August 12, 2013
Thank you, Speaker Norelli, for that introduction. It’s great to be with you and the other NCSL leaders again after our meeting in Washington earlier this year. And I want to thank you all for being here and for your service to your states and to our country.
As a recovering state legislator myself, getting the opportunity to come to NCSL feels a lot like home. I’ve seen firsthand the incredible work you do—from strengthening local economies to helping families gain the opportunity to live safer, healthier, more productive lives.
And today I’d like to talk about some of the ways our Department is working with states to meet the challenges and seize the opportunities your states have ahead.
For starters, we know that quality early education is critical to the emotional, social, health and wellbeing of our children, families, and communities. These might be the best investments we can make in the future, and President Obama has proposed an historic federal-state partnership aimed at getting all of our children ready for school success and lifelong learning.
Focused on supporting our children from birth to age 5, it starts with increased investments in home-visiting programs to support parents and caregivers in their role as a child’s first and foremost educator. We’re then building on the great work states are doing with Early Head Start and Head Start to improve early learning quality and curriculum in the places where many of our children spend their early days.
And these improvements for infants and toddlers lead to partnering with states to provide every child in America with access to affordable preschool. It’s a plan that helps them perform better in school and saves working families hard-earned dollars in daycare costs. It also strengthens our communities by savings on public assistance and criminal justice programs.
These kinds of investments have bipartisan political support. Business and military leaders, teachers and child advocates have called for these investments. And I look forward to continue working with you to make sure that more of our children have access to early learning experiences that can make a lifetime of difference for their health and wellbeing.
But we also know their future—and our country’s future—depends on the overall health of all of our families and their communities. As some of you will hear later from Dr. Frieden, our Director of Centers for Disease and Control and Prevention, ensuring people have access to affordable, quality care is a pressing public health need.
And that’s the need the Affordable Care Act is designed to meet.
I know you’ve already heard from Chiquita Brooks-LaSure and Cindy Mann, who represent the great team from our Department, about our ongoing work implementing the law.
But just as a reminder, the first thing to know is that for the 85% of Americans who already have insurance—the law has already improved that coverage.
First—being a woman is no longer considered a pre-existing condition. And soon no one will be denied insurance because of a pre-existing condition, like diabetes, cancer, asthma, or anything else.
More than three million young people now have insurance under their parents’ health plans through the age of 26—giving them the freedom to pursue their dreams without worrying about their health coverage.
Seventy-one million adults with private insurance can now get many types of preventive care, like cancer and cholesterol screenings, at no out-of-pocket costs.
Last year alone, nearly 3.5 million seniors on Medicare saved an average of more than $706 each on their prescriptions—enough to cover 2 or 3 months worth of groceries.
In 2012, 8.5 million Americans received more than half a billion dollars in refunds because insurance companies didn’t spend at least 80 percent of their premium dollar on medical care and quality improvements.
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, or for Americans who buy their own insurance right now but aren’t happy with it, they’ll have better options coming this fall.
First, a new online Health Insurance Marketplace will open for individuals and small business owners in every state through HealthCare.gov.
When open enrollment begins on October 1st, the Marketplace will give families a whole new way to find coverage that fits their budget—and the benefits start in January.
All plans in the Marketplace must 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 since these consumers don’t have affordable employer coverage, many individuals, families, and small businesses will qualify for a break on the costs of their monthly premiums.
Because of the Marketplace, insurers will now have to compete for business the way that all companies do—by offering the best products at the lowest price. We’re moving past the days where insurers could just lock out, dump out, or price out anyone who might get sick.
And here’s what we know about the new rates in the Marketplace. While it’s unfortunate that some states have inaccurately speculated what the final rates will be, we’ve heard some great news from many of your states about rates that have been finalized.
New York announced that premiums could be 50 percent less costly in their Marketplace than they generally are today. States from California and Oregon to Maryland and Vermont have all announced rates for plans offered through the Marketplace that will also be significantly more affordable than the current market. All the state rates will be available by the end of September—but so far, there is plenty of competition and positive news for consumers.
Another way the health care law is covering more people is by building on the Administration’s efforts to strengthen Medicaid.
From day one, we’ve known that states are the laboratories for innovation—and it’s why we’ve worked to provide the flexibility and support to test strategies to improve care and bring down costs in the Medicaid program.
Right now, more than 20 states are working to better coordinate care for their Medicare-Medicaid enrollees, and share in the savings. Other states are implementing or receiving planning grants for Medicaid medical health homes to reduce unnecessary hospital costs.
More than $300 million has been awarded in performance bonuses to 23 states making innovative, sustainable improvements to their children’s health coverage. And earlier this year we announced another $300 million in innovation grants to help states test statewide models for improving care and lowering costs.
And despite some of the rhetoric in Washington, the cost outlook for Medicaid is as strong as it’s been in a long time. In 2012, Medicaid spending per beneficiary actually fell 1.9%, the first time it had fallen in 47 years, except for the year when prescription drug costs shifted to Medicare Part D. As a result, our independent actuary has estimated that Medicaid spending will actually be 14% lower than previously projected in 2020.
It’s clear that state reforms aided by HHS support are working. And going forward, we will continue to work with each of your states to give you the flexibility you need.
But there’s perhaps no greater opportunity to strengthen Medicaid than by expanding the program in your states—and providing millions of previously uninsured parents and adults with health coverage.
Medicaid expansion would reduce the burden of uncompensated care by billions of dollars across the nation. It would create local jobs and inject significant resources into local economies and hospitals. It would free up state dollars that can be invested in 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 reliable health coverage.
As a former governor and state legislator, 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 never less than 90% after that. And the program is fully paid for; not a dime is added to the federal deficit.
I know some of you have concerns that this deal could be changed. But if you look at Medicaid’s history, you’ll see that there’s no precedent for the federal government cutting its matching rate. Furthermore, states are free to take up the coverage expansion at any point and they are free to drop that coverage, without financial penalty, at any point.
So we’ve been pleased to see governors and legislatures from across the country and the political spectrum seize this opportunity. And the door will remain open for others to walk through.
But if states don’t expand their Medicaid programs, a lot of people in your district could fall through the cracks, with no support and no source of affordable health coverage at all. We can’t let that happen.
There’s money left on the table and lives left at risk. And no one’s health should depend on their zip code.
But here’s the key point: just because new coverage options may be available doesn’t guarantee that people will even know about them, let alone take advantage of them. And getting them covered shouldn’t be about politics or ideology or winners and losers.
Remember, the debate in Washington is over. The President signed the law. The Supreme Court affirmed it. The people have spoken and President Obama was re-elected. Now it’s about making sure that people know about the choices and opportunities that are about to become available to them—in many cases for the first time in their lives.
Over the last three years, I’ve traveled to more than 100 cities across nearly all 50 states meeting those families, small business owners, and people of all ages who are excited about what’s ahead and hungry for information.
They simply want to cut through the clutter and hear the real facts. And when it comes to something as serious as their health and the health of their family, they deserve that chance.
That’s why HealthCare.gov will make the process easier and more transparent for millions of Americans.
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. For those who prefer the phone to the computer, there’s a 24/7 customer call center ready to answer questions in 150 languages. We will have trained volunteers, at health centers and working in communities across the country, to provide one-on-one assistance.
But we also know that we can’t do this alone—and that was never the plan. And even if you’re not the biggest supporter of the law, your constituents who stand to benefit from the law will be coming to you with questions—and we want to help you with the answers.
That’s why we have a toolkit specifically for elected officials—copies are available in the back of the room today, so you can get started right away. I also want to thank NCSL for including the toolkit on their website, so you can download a copy once you get back to your home district.
And we also have dedicated, knowledgeable staff in our 10 regional offices around the country, who can serve as your go-to resources. Our Regional Directors are leading the education and outreach efforts on the ground and can ensure you’re connected to efforts underway in your area.
On October 1st, we’ll be ready to finally offer millions of Americans the health security and peace of mind they need and deserve.
Getting your constituents signed up for health coverage is the smart thing to do for individuals, for families, and for your states.
And it’s the right thing to do so that health care is available to everyone—and so we can build a healthier, more prosperous country together.