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National League for Nursing 2013 Education Summit

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Washington, DC
September 18, 2013

Thank you so much, Dr. Halstead, for that very warm welcome, and thank you all for standing at the front end of my comments. 

But I have some bad news for you.  If you think that counts as your exercise today -- it doesn't.  But I am really delighted to be with all of you, and I want to start by just thanking Dr. Halstead for the important work she's done in leading the National League for Nursing, but also for the work she does each and every day with students at Indiana University.  And I want to also give a special warm Washington welcome to the headquarters of the National League of Nursing which after a century and a decade has moved from New York to Washington. 

And I want to welcome you here to the nation’s capital.  We are thrilled to have you as neighbors. 

I want to thank my friend, Beverly Malone, for inviting me here today, recognize her great work as the CEO of this important league and tell you that Bev and I go back a long way.  In the mid-90s, when both of us were teenagers, we actually served together on a commission that President Bill Clinton appointed us to.  We were two of about 20 members of this commission.  It was an advisory commission on consumer protection and quality in health care.

Sound familiar?  And actually many of the provisions that are in the Affordable Care Act around consumer protection, many of the new rules for insurance companies and rights that consumers have came out of the Clinton Commission in the mid-90s that were never enacted in the '90s or 2000s, but finally got written into the 2010 law.

I also just want to say a special word of thanks to all of you.  And I say this not only as the Secretary of Health and Human Services in my current position, but I say it really as a recovering governor who used to fund nursing programs throughout the state, and really as a daughter whose mother was ill for a long period of time and what I knew in her health care experience was I often couldn't get the information I needed or the care strategies I needed on a regular basis from the doctors who were in and out of the room. But I always could find a nurse who was leading the care plan, leading the care strategy, and really at the front line of taking care of her. 

So, it's from that perspective I really want to thank all of you for your incredible work.

You know without those of you in this room we clearly would not have the pipeline of nurses that we have to not only provide critical leadership, but the compassion and advocacy that meets the needs of millions of Americans.

And I think what is one of the most exciting aspects of what's going on today -- which is really the transformation in the delivery of health care – is returning a lot of the authority to providers, and putting together care teams that are delivering care in a much more strategic and much more effective way. 

We have some key nurse leaders in our department.  Marilyn Tavenner is an RN and has now been confirmed, the first confirmed administrator of the Centers for Medicare & Medicaid Services that we've had in over six years. Marilyn is leading that critical role. 

Mary Wakefield, another terrific nurse, and actually another co-member of that Clinton Commission, leads our Health Resources and Services Administration, and not only in her portfolio are all the nation’s health centers, but also the whole workforce portfolio that she leads looking out for graduate education and nursing education, physician assistants, doctors, mental health professionals.

So I am deeply in debt to the nurse leaders each and every day that I go to work, and I know that those of you in the room made their service possible and make nurses all over this country able to do their work.

I want to spend a little time talking about why nursing education matters today more than ever and I also want to ask for your help.

No one in this room needs to be reminded that there are incredibly important ways each and every day that nurses touch the lives of families in our country, making sure that our youngest moms know how to care for their infants, and the nurse visiting program is one of the critical areas funded by our department, and that is really making a difference in the lives of the youngest Americans; showing an elderly patient how to manage his or her diabetes; ensuring that children and adults get the vaccinations that they need.  The role that nurses play has never been more important than it is today. 

Now, over the last several years I've been in more than 100 cities and almost every state in the country, and I often have an opportunity to meet with nurses at the front lines of the health care system. 

And as you see firsthand, they are on those front lines each and every day helping to make America a healthier and more prosperous country, helping to make sure our workers are in better shape, our students are able to learn, and our children get the healthiest starts possible.

The nurses I talk to tell me all kinds of stories about the patients they serve, stories about patients with heart disease, whose lives would've been much different if they'd only had access to a cholesterol check; patients whose cancer was detected, but detected too late, too late to really save a life or be operable; patients with serious illness that could've been avoided if they'd had access to better sources of information or a primary health home, or a health strategy.

So, part of what the President did when he signed into law the Affordable Care Act was to look out for those patients, people who actually fell through the cracks, who couldn't take advantage of what we know to be the best medical care the world has to offer, and often didn’t have the opportunities that some of us have in this country to achieve a full life.  In fact, they live sicker and die younger than their neighbors and friends.  So this law has really given nurses another historic opportunity, an historic opportunity to continue to help Americans, by making sure that they have access to some of those services and support. 

We have built the law around many of the strategies that you all know work in the first place, strategies like:

Making sure that access is increased to primary care. 

Frankly, one of my passions and goals that I continue to work on is working with state partners to unlock the scope of practices in states around this country  and let people practice like you trained them.

Making sure that our first emphasis is health and wellness, keeping people healthy in the first place. Teaching them strategies about taking care of their own health and wellness is far less expensive and far more productive than waiting until individuals get sick.

Making sure that we make the most of health care teams, and the best hospital systems in this country. The best practices in the country are using teams empowering everyone to really make critical decisions and deal with patients on a regular basis. 

Making sure that we make the most of teams that actually reach out and visit patients in their own homes. We have this aging population that can really age in place, exactly what people want to do, and not be relegated to having to make choices in order to access care.

So nursing education is critical to all of those decisions, all of those pivots, all of those opportunities. 

As health care and patient care in particular continue to evolve, more nurses are going to need more training in a variety of new and complex technologies.

At Health and Human Services, we want to support that.  We're investing in priorities like scholarships and loan repayment to help nurses attain new skills, and to help aspiring nurses as well.  And the investments are already delivering results. 

Through our National Health Service Corps, which I personally believe is one of the most important initiatives we have in this country, we agree to pay people's medical debt or pay for scholarships if they serve in an under-served area. We've already more than doubled the number of health care professionals working in under-served communities since 2008, and that's a really big step forward. 

We now have more than 1,600 nurse practitioners and nurse midwives working in under-served communities.

Through the Nurse Corps Loan Repayment Program, we've helped more than 700 nurses in the past school year with their loans, including 214 nurse educators, because you can't really have nurses without nurse educators, right? 

And when I meet with faculty and administrators at our nursing schools, they tell me how difficult it is to recruit and retain qualified faculty.  And, as I say, we all know without faculty we won't have the next generation of nurses.  So to help tackle that very specific challenge, we're investing through the Nurse Faculty Loan Program to help RNs complete their graduate education to become qualified nursing faculty.

We're investing in nurse-managed health clinics.  And, as you know, many of those clinics are directly affiliated with schools of nursing. 

Now, part of the magic of these clinics is that they're important not only safety nets for vulnerable families, but they're also great tools for training the next generation of nurses.  In fact, by investing in these new facilities and figuring out different care models through the Affordable Care Act, we helped train more than 2,400 nurses in the last school year alone. 

Twenty-four hundred additional nurses, and that's great news. 

Now all of those investments in nursing, most of them a direct result of the Affordable Care Act, are just part of the difference the law is already making to strengthen health care in the United States.  That's a footprint of some of the efforts that we've had on the education side, and now it's my turn to ask for your help. 

You and the students who you serve and come in contact with every day are informed validators of health care.  You're passionate advocates for keeping people healthy in the first place, and when it comes to making informed decisions about health, I know that many people turn to their nurses as friends. 

I know they turn to nurse educators.  I know they turn to their neighbors who are nurses.

One of the most important pieces of the health care puzzle is access to quality health insurance that families can actually afford, making sure that they have a primary health home, and making sure that they can pay their bills.  We know, study after study has proven, that good health coverage is critical to good health, to financial security, to peace of mind, and also that people who have coverage likely get better health care.

Too many people have been standing on the outside of coverage for too long, and you can help us change that. 

Millions of uninsured or underinsured or sometimes insured Americans will be eligible for benefits under the new law.  And what begins October 1, in less than two weeks, is a six-month education-open enrollment period. 

It is an opportunity to give people information about what the law is, about how they can take advantage of the benefits, and how they can make some good decisions for themselves and their families.  And here's how it works. 

Eight-five percent of Americans already have insurance. They're enrolled in Medicare.  They have Veterans benefits.  They work for a large employer.  They work for a company that provides good health care.  And their coverage doesn't change.  It actually has gotten stronger with some of the patient protections that are in the law, but they don't have to do a thing going forward.

But for that other 15 percent, folks who are working on their own or who are totally uninsured or who are in and out of the market, or maybe locked out because of a pre-existing health condition or can't afford coverage because their employer doesn't offer any coverage, those are the individuals who will have some new opportunities in the new marketplaces.

Coverage begins as early as January. All the plans in the new markets are quality health insurance.  They have to offer a set of essential benefits, such as doctor visits, maternity and newborn care, mental health services.

Some people for the first time ever will have access to services that actually can keep them healthy in the first place.  Insurance companies will never again be able to deny someone health insurance because of a pre-existing health condition. 

Those days are over. 

And when you think of the health profile, about half of the citizens in this country, and my guess is about half of the people in this room, have some condition that an insurance company has identified as a pre-existing condition.  And if you are in a workplace without a group plan or without affordable coverage, you're often at the mercy of the market. 

And guess what?  Being a woman is no longer a pre-existing condition. 

It will not be legal any longer for insurance companies to charge women in the individual market significantly more than men.  Right now a lot of women pay 50 percent, and sometimes 100 percent, more than their male colleagues or friends do for exactly the same coverage.

But just because this new law is in effect, and just because open enrollment is about to happen, it doesn't mean that we should assume people know about it, or certainly that they know what to do about it.

So connecting people with information, getting them some help that they may need, getting them connected with the information that could make a huge difference for themselves and their families is an opportunity we can’t ignore.

So I need your help.  I need your help reaching out to your faculty, colleagues, members of your local community, your Facebook friends, your church group, your neighbors, and friends, because I can tell you they will listen to you. 

We need to have you help us share the information about our website, healthcare.gov.  Healthcare.gov becomes an enrollment site on October 1.  It's a one-stop site where people for the first time ever will be able to compare plans side by side with nobody pushing them to buy insurance, be able to figure out what things cost, be able to qualify for health benefits.

If they're Spanish-speaking, we have great resources at cuidadodesalud.gov. 

And I can guarantee you it isn't your typical government website.  It's user friendly.  It's easy to understand.  It even has a webchat feature, so if you need help along the way, like when you're buying a pair of shoes and want to see what color they come in, somebody comes on the line to chat with you.

We also know that lots of people aren't web savvy and don't feel comfortable dealing directly with a computer, so we currently have up and running a call center operating 24 hours a day, seven days a week.  We have translators available who can answer questions in up to 150 languages.

I visited the call center, one of the sites two weeks ago in Tampa, and I repeated that line and said, "How does this work?  How do we answer questions in up to 150 languages?"  And I was able to watch a call come in, somebody speaking Mandarin Chinese on the other end of the phone.  They didn't know when I was going to be there or what language was going to be asked for.  Within 90 seconds we were able to get a translator on the line with the caller and the expert and go through a series of this gentleman's questions in Mandarin Chinese. 

So I can tell you I've seen it in action.  It really works. The toll-free call line is up and running for people who would like to speak to a live human being and walk through questions or decisions. 

We also have a feature on the website that says where to find local help.  So if you are in Florida or Connecticut or California, you can actually go to the website, pull up that feature and find where there are trained individuals in your own community if you want to meet face-to-face with someone and get information.

So we're trying to anticipate people who can navigate this online, who want to talk to a live human being on the phone, or who may want to meet face-to-face. 

But what I know is this.  You often, nurse educators, will often be the most trusted sources for health information. 

You'll be ones that people will turn to ask questions.  And who better than you, nurse educators, to make sure that your students know where to get clear and accurate information, where to share that information with their patients and the people that they'll be dealing with, how to sign up for coverage in the new marketplaces.

There is a website especially for you and other faculty and other health care providers that has a whole toolkit of ready-made resources for you to download and use when you're educating your students or members of your community from health fairs to board rooms.  The website specifically for providers and educators is marketplace.cms.gov. 

You're going to hear in a little bit from Dr. Matt Heinz, who is our head of provider outreach at HHS and he will walk you through some of the website features, but again, we're trying to anticipate that you may need materials to back up your information -- we've got videos, brochures, and other resources already prepared. 

And I hope that we can count on you as educators to talk and teach about this historic opportunity. 

I know there's a lot of buzz in this town about the fact that this is still a political debate, and there are clearly members on the Hill who feel that voting on this law over and over again is the only thing that they'd like to do for the next three years of their lives, but here's the real deal:

The Affordable Care Act is the law.  It was passed by the United States Congress.  It was signed by the president of the United States in March of 2010.  It was upheld by the Supreme Court in July of 2012. 

The president was re-elected.  This is the law.  What we're talking about is getting people benefits under the law.

So I want to tell you about a story of one of your colleagues who was with me at an event I did in Pittsburgh the other day.  And I think it's just an example of the kind of individuals who we may not think of right off the top of our heads, but who will be enormously benefited by this new law. 

Cathy Stoddart is at the Allegheny General Hospital, and she's a transplant nurse.  She and her husband have always worked full time, and they've had what she thought was pretty good health insurance.  But what she found out along the way was that they were seriously underinsured.  Cathy and her husband were thrilled years ago to have a baby boy. 

He was born with a very serious heart defect and required a series of surgeries.  And although he had the ability to have those surgeries and Cathy was part of the health care team and knew exactly what he needed for her care, they quickly found out that the out-of-pocket costs and the co-pays for these surgeries was devastating.  They finally resorted to putting some of those costs on credit cards, because it was the only way they could go forward, and finally it resulted in a family bankruptcy.

Now, they thought they had insurance coverage.  They thought they were going to be okay.  They clearly would do what any parent would do, anything they possibly could to make sure that their child was going to survive and thrive.  Their credit history will never be the same.

The good news is that their son is well and healthy.  He is about to graduate from nursing school as we speak.  And become a nurse like his mom.

But as Cathy said, there are millions of people like her all over this country, millions of people who really thought they had coverage only to find out that they are not covered for the most serious illness, that they have out-of-pocket limits that are simply unaffordable, and that they have a life or death decision to make.

The new law protects people like Cathy in the future.  You will have a yearly out-of-pocket limit in your insurance policy, and a lifetime cap that you will never have to pay any more funding.  It will make sure that never again will somebody go bankrupt because they get sick.  They will never have to stop an important treatment plan because they have an illness.

So I think about Cathy all the time, because often we focus on individuals who are uninsured who have an historic opportunity, but there are also lots of Cathy Stoddarts in every place in this country who currently have some kind of coverage, but it doesn't really cover them when they get sick. 

We have an historic opportunity, and I can't imagine a better group to be with than those of you who are nurses and nurse educators.  We are in a position where we can really offer to millions of families across this country health security for the first time in their lives, and an opportunity, frankly, to lower overall health costs by getting people the preventive care and the check-ups and the health that they need in the first place. 

So again, thank you for what you all do each and every day turning out the next generation of great nurses. But thank you for the help I know you're going to give us and your neighbors and friends, getting information about this act out around the country. And have a great conference. 

And welcome to D.C.