families, businesses and government 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 is the basic outline. one way to carry out law is to make a changes immediately but that is likely to totally overwhelm our health care system and wouldn't give us enough time to work with states to design a new functional health marketplace. since the president's goal from the outset was to strengthen the current health insurance system for all americans without disrupting it, we took a different approach. the law implements reforms quickly but not all at once and instead they fit together like puzzle pieces, one neat refitting into the next. we know we had to give some immediate relief to millions of americans struggling with the current health care systems of for many of them there really is

help right away. for example, starting on june 15th of this year's seniors who have hit the prescription drug gap will get a $250 rebate check some time between now and the end of the year to help them for their medicines this year. there is a new tax credit available in 2010 to help small business owners like the man who wrote me and said as a small-business owner i am near the breaking point. guaranteed annual increases 10 to 15 times inflation eventually i will go out of business or be forced to cancel insurance altogether. at the same time we are adding new protections that make insurance stronger for americans who already have it. the new rules ends lifetime caps on benefits and that takes effect this year. so does a rule preventing insurance companies from canceling your coverage when you get sick which happens to people each and every day. the new health reform law makes

easier for americans to get insurance. right now is legal for insurance companies refuse to cover children who have a pre-existing condition. we have an insurance system right now that often exclude the young people who needed the most. starting this fall that practice is outlawed. benefits will have to be covered and the children themselves will have to be covered on policies. we are also creating a high risk temporary pool program available to adults are currently shut out of insurance because of their pre-existing condition. young adults and a need coverage will stay on their parents's insurance until they are 26. all of that happens this year. during early years of implementation we will work with providers across the country. to turn medicare into a high value healthcare purchaser.

when seniors walken to hospital they should get the best care possible each and every time and we run the world's largest health-insurance program. medicare has a lot of clout when it leads by example. if medicare can find smarter ways to pay for care other insurers will copy them and we will all get better results. under the new law americans will get more control over their health care this year. by this fall it will be easier for seniors to get medicine, 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 questions about what happens this year or you want to see the list of first-year benefits i encourage you to visit our web site early and often. healthreform.gov. what will make these reforms more effective is it builds on

some significant improvements that were made to the health-care system in 2009. it is part of this story that a lot of people have overlooked. one of the first bill that president obama signed into law was the ship reauthorization act and by the end of last year we have already enrolled 2.5 million previously uninsured children in the program and in medicaid. we have five million more we think are eligible and not yet enrolled. that is a major effort underway. with the passage of the recovery act early in 2009, which was primarily a job creation bill but also one of the biggest health innovation bills in american history. under the recovery act we funded prove and local health and wellness strategies to give families more health choices in their neighborhood. expanded almost double community

health centers which provide high-quality primary-care to nineteen million americans a year, invested in the national health service school to strengthen the primary care work force especially in underserved areas and made a historic investment in health information technology which helps patients fill out fewer forms and helps providers deliver better care. i saw an example of that kind of improved care in 20 first century delivery yesterday when i was in cincinnati and visited children's hospital. they have a very innovative technology system throughout the hospital dealing with the sickest kids not only in the ohio region but they gather children from across the country and from international sources because they are renowned for doing some very complicated surgery is. i visited the intensive care

unit and part of why they are having such success is their use of electronic health records. they have had a thousand days in the hospital without any safety incident which is a record that a lot of hospitals would love to replicate and they do it with a checklist at every incubator reminding providers of various steps that have to be taken, safe and secure as possible. i am happy to announce the last round of health information technology which helped create 60 health it extension centers across the country. think of these centers like apple geniuses, a small provider group or the doctor's office wants to switch to electronic records, they have a health extension center close at hand

to help them implement these strategies getting expert advice and technical assistance they need to get the system up and running. so those building blocks of 2009 are now the template that the new reform is added to in 2010 and we end up beginning to see the health care system where it is easier to get coverage, easier to afford care or find a doctor and access the your own health information. the health care system where americans are going to get a lot more help for the investment we are currently spending, the changes create the foundation for 2014 when some of the major features of the new law kick in. that is when the health insurance exchanges become operational and tax credits become available for individuals and families to help buy

insurance coverage. this is a huge breakthrough for health care consumers some of whom have no coverage at all and some are desperately underinsured. the questions so many people write to me, where can i find affordable insurance, we find insurance for every person in america. instead of visiting dozens of websites and shopping a market on your own, it will be a 1-stop shop where the benefits for different plans will be clearly listed and costs are compared, that is part of the new law and as america's help desk, make sure every american knows about the choices that come out of it. over the next several months we will be reaching directly to americans across the country to make sure they know how to take advantage of benefits in the new law. we will educate seniors about prescription drug assistance. we put out a series of fact

sheet that explain step-by-step to small-business owners how they can collect their health care tax credits this year. we have similar fact sheet from employers to take advantage of reinsurance program that also hit this year. it will help them provide coverage for early retirees. book marking the web site, healthreform.gov will give regular updates on these reforms when they are putting place. you can go there to read the fact sheet, get questions answered and watched weekly web chats. we will take questions live from around the country. we are working with a lot of stakeholder groups who broadcast information about the bill more widely and we realize a number of the populations we need to reach may not be so tech savvy so we are reaching out through partnerships and collaboration. 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 are going to tell you but ultimately we recognize that actions do speak louder than words and no matter how good a job we do educating americans about the benefits in the bill it won't be much use unless we also implement those policies responsibly and effectively. the president has already said to me many times we need to get this right. the letters i get every day make it clear we have no time to waste. in the week since the president signed his historic legislation into law we started act during. we started restructuring medicare and medicaid services so it is better prepared to take on the new responsibilities under health insurance reform. last friday we began working

with some of my former colleagues as governors to create high risk pools to help uninsured americans with pre-existing conditions that they need to get coverage. today we're sending new guidance to medicare advantage plans which includes strong for cost sharing protections for all seniors and later this week we open new medicaid options to cover low income adults. unfortunately some of the scam artists are moving just as quickly. we heard reports from at least a couple states to report crookes trying to capitalize on the new law and setting up a hundred numbers going door to door in senior centers trying to sell fraudulent insurance. the kind of criminal activity which preys on americans who are the most vulnerable in our health-care system and it is totally outrageous. that is why i sent a letter to my former colleagues, state insurance commissioners and our

country's attorneys general to ask them to investigate and prosecute these kinds of scams and also to put seniors particularly on notice that medicare sales aren't conducted door-to-door on the usual basis. the kind of communication and collaboration will be a key to making the law work for every american. over the next few years we work with providers, employers, consumers and seniors to get the law right. many reforms are carried out at the state level. i did serve for eight years as an insurance commissioner and i know how tough and effective state regulators can be. that is why the states are presumed to have the responsibility to oversee the development in insurance exchanges, provide regulatory oversight and consumer protection. the law provides resources and assistance to states but when it comes to the specifics we assume the people on the ground

actually know best and can do the job best. i served as a governor and i understand the kinds of budget challenges that states across the country are facing and i said over and over again that this bill is an incredibly state friendly bill. no question that as the market begins to expand in 2014, part of the law makes that a partnership between the states and federal government. for the three years following 2014, the federal government picks up 100% of the bill and after that, states start paying a share which rises to the top total of 10% by 2020. there are some new costs in insurance expansion borne by the state but i would argue those costs are far balanced by new benefits to states including less spending on compensated care which states spend on each

and every day, saving from reduced insurance paperwork, more resources from the federal government to cover children in every state, more money back to crack down on fraud and abuse and that doesn't even count the people who get better care with healthier lives and end up as more productive workers. as of former gov. i can say unequivocally if my state had been offered this deal during my seven years as governor i would have taken it in a heartbeat. we intend to work closely with the state as the federal department for implementing the bill. i want to share a couple operating principles for making sure the full benefits of this law reach the american people. we will be transparent and that just doesn't mean sharing what you know. it also means making it as convenient as possible for the american people to access that

information. today we are announcing the first time ever release of medicare data which we are calling our medicare-board. this is an online tool to make it clear for americans to search and sort aggregate medicare data with full protection for patient privacy. we are launching medicare's in patient hospital data where you will be able to sort by state, by condition and by hospital making price comparisons for the first time ever but it is just the first step of many. we will be giving purchasers and providers the health information they need to make smarter choices. we believe we have to make every dollar count. it is a principal we will applying to every step of implementation. we are depending heavily on

people and systems that are already in place not starting with the assumption that we have to build a new bureaucracy. our department has incredible talent the personal great resources and expertise in the health care system. as we move forward we rely on our existing resources as much as possible to fulfill our new responsibilities under the law. third and most important, we don't ever want to lose sight of why we are pursuing this legislation in the first place. we fought so hard for it and are celebrating a historic accomplishment. over the last year i have read letter after letter from families and small business owners who feel totally powerless in the existing health-insurance system we have. their premiums continue to go up sometimes by 50% a year and they don't understand why. they argue with their insurance company but they are afraid the coverage would get canceled or they would be penalized. they would switch to another

plan but don't have any choices or options and sometimes with pre-existing conditions they absolutely no they can't get another policy. even americans who have good insurance through their jobs worry about next month or next year, worry about their kids or families. they see more and more of their pay checks being eaten up by rising premiums every year and they know how quickly the partial security they have could disappear if they lost their job or switch jobs or retire. our goal is to put these americans back in charge of their own health care providing information and education if it is needed, said it basic guidelines that will foster a competitive insurance market, serving as an umpire to make insurance companies treat all americans fairly and providing targeted resources to help empower consumers but ultimately this isn't about us. it is about the american people. it is about giving americans more choices, more security,

more control. there will be bumps along the way. there will be twists and turns. it won't be easy but after decades of standing still we are finally moving forward. i am pleased to be with you and i will be happy to take your questions if you have questions. [applause] >> thank you for your address. i want to apologize in advance if i referred to you ever as governor as i asked you governor so many times, understanding the identification we are proud of kansas. we should have been playing for the national championship lt night. i am sure your family in ohio and my family and minnesota were also following the state of kansas very closely as well. leading into this your experience as a governor of the state of kansas and your first statement that you would have jumped and this opportunity had you been governor when this came

through, several governors have jumped and this opportunity and they are trying to stop this plan. can this is not one of them but several states are and with them during up for a big legal battle, why do you think this happened and do you fear that these lawsuits could slow the progress of health reform? >> the vast majority of lawsuits have been filed by attorneys general in states where they have some interest in higher office and in consultation with our legal team and their consultation with the justice department we are confident that the law is on solid constitutional ground, on firm ground. i am going to let the lawyers debate the situation. our job is to talk to the american people about what

really is in the bill, how it will work to their benefit, and that is where we will spend our time and energy. we are confident the legal standing of the law is solid and this has more to do with politics than policy. >> there were a challenges from the conservative side. you also have people on the left hand of the spectrum saying this is a start and could go other direction. to what extent would you characterize this health-care reform plan as a start and if there may be health care reform that should be taken once this comes implemented. >> there was a wide spectrum at the beginning of the debate. people who felt what would be advisable scrapped the third party insurance system to start

again. a single payer system bearing what a lot of developed countries have who said what we really need to do is have a total market strategy. and get rid of the barriers that prevent them from operating in a creative way and the market strategy to solve the situation. the president and congress chose a middle ground approach, not dismantling of the markets, 1 eighty million americans have employer based health insurance, they like it. not dismantling the insurance rules but figuring a strategy that made it stronger and opened up the private market, creating new marketplaces for thirty

million americans who don't have coverage currently. i am sure overtime this law will be revisited. my dad was in congress in 1965 when medicare was passed. he served on the energy and commerce committee. medicare has changed a number of times in the 45 years it has been in place. we wouldn't recognize what the law looked like but the template is saying once you reach 65 or severely disabled, guaranteed health care. to principle has been under constant improvement. the principal of san all-american men's should have affordable health care is one that we will continue to work on but is a significant step from any place we have been before in the united states.

>> what insurance industry will comply rather than look for loopholes and what steps will you take if this happens? >> i think that there is a principle that has been in place in health insurance for a number of years which isn't terribly complicated. it is a lot cheaper to insure people who promise not to get sick than people who do get sick. the same principle used in property-casualty coverage where you don't want to insure homes in tornado ally like kansas. you would rather find a place where storms don't hit. working with the insurers to actually look for way is to make a new business, it will require oversight and vigilance. it means changing the rules.

it also means insurance companies will be competing on the basis of price for new customers and have to be not basing their customer selection on cherry picking the market, eliminating certain groups and individuals. insurance commissioners at the ground level will have the initial responsibility for oversight protection. we have urged them and in some states there isn't a legal authority to have rigorous rate review to have actuarial studies done before rates are increased. you can see some states have been very aggressive in limiting the kinds of rate increases that have been allowed. it will require states stepping up, becoming more vigilant on rate review, more vigilant on

consumer protection and we will be working as a backstop to that. the trade off of having additional customers in the private market means the new rules will be followed and will be vigorously enforced. >> one member of the audience asks how did the student loan direct a program get into the health care bill? >> it turns out the history of reconciliation bills often have included in the past education and health measures together. they both have significant budget impacts, that is the measure of reconciliation. if there is a significant impact on the budget, the student loan and community college reinvestment bill has been passed by the house of representatives, was being considered in the senate and members of the house and senate thought that it was an

opportunity to accelerate passage of a historic piece of legislation. $68 billion over the first ten years will be saved from eliminating the third-party loans that are going to benefit students who want to attend college and reinvesting those funds in doubling the telegrams and raising the threshold of pell grants for the first time in fifteen years and limiting the payment of loans. one of the most inspirational pieces of the puzzle is a student, a graduate will never pay more than 10% of his or her income to pay back the loan. encouraging people to take on jobs that may not pay as much. social workers and teachers will not be eliminated from taking on

those jobs. if after ten years you have paid the full amount you are considered finished. they don't want graduates to consider to pay after a decade. if you have military service you are considered to have your debt paid in five years and encouraging public service. this is a major investment i would highly recommend to the press club if you haven't had secretary duncan to talk about this legislation. it is a conversation worth having. >> can you help us get secretary duncan here? >> sure. >> we appreciate it. tell us more about the low income medicaid possibilities you spoke of in your remarks. >> starting this year we had opportunities for states to immediately covered the so-called childless adults population where a lot of

uninsured americans fit into that category. some have moved ahead and are covering that population but getting no federal assistance or helped for doing that. the first step is likely that states that are currently providing state only funds for the population will hopefully expand the population. others may well since it is a medicaid match of 60% federal dollars, the deadline, opportunity for federal funds. >> the national high risk program calls for this program to be in place for three month and many questions need to be

answered in high risk pools to develop them in states that have plans to develop pools. they published what it promised to provide. how realistically do you think they will secure coverage? >> 34 states, some sort of market, too expensive for many individuals. the price will be pegged at 100% of market that are not

inexpensive. they have a federal fall back, at the regional level. we work one on one with the state groups to figure out how they want to set it out and get up and running and we will be the backstop for americans who don't have the pull in their own state and they want that coverage bill. >> we are going to have dennis quaid. potentially deadly medical errors because of the tragedie

experienced. is there anything that addresses the problem of medical errors and prescription drug with stakes? >> there are lots of quality improvement measures. there's a huge impact on hospital errors. there's no question that having the ability to pursue middle having a provider to enter, and the drug puts a red flag up so we do not have the wrong medicine ordered for that patient population. in a hospital -- they also have

a bar code dispensing system where you cannot release the drug from a prepackaged system unless it is bar code. the baby and is visiting with his mom is four weeks old and has a wrist band that bar code did. the mayors indicated to me she has to bar code the dispenser where the drug is not released to make sure it is the right patient, the right dose at the right time. that is a huge step forward. 20% of hospitals have some electra and record but not nearly enough. that is what investment is about. there's also a lot of information and research going on about how to work on hospital associated infections which is another huge issue. 100,000 people year die in american hospitals not because of what brought them to the

hospital but what happens to them when they are in the hospital. hundreds of thousands more have a very costly, consuming injuries because of that same situation. the challenge we have taken on with the american hospital association, there are some simple checklist's that have been shown to dramatically reduce hospital associated infections. two thirds don't require new equipment, don't require any fancy training. they're just not implemented in hospital after hospital. they're not in place in too many medical care. we currently pay the same amount for incidents whether or not something happens related to hospital safety or not. we are paying until last year for so-called never incidents where the wrong limb was amputated. the wrong drug is given. a patient is dropped on the

floor. you get the same payment out of the insurance system as the best possible results. we can use the payments system to begin to drive to put incentives to promote better care but eventually disincentive and we have to do that very quickly. >> there's a shortage of gerontologists as the population ages. how can this be solved and what rolled to use c h h s playing? >> there's a shortage certainly on the specialty of the aging population and a shortage of primary care and family care doctors who have the same skill. we have begun to change the payment formula to more appropriately compensated

medical providers who choose a range of family primary-care services. we will continue to accelerate that. we are part of the investment act in 2009. part of the recovery act in terms of work force initiatives and part of this bill helps us build more ample primary-care work force and for the future which again i think is critically important and paying more scholarships to providers who work in areas where we see a growing need and gerontology is one of them. >> what is your own view of using acupuncture, meditation and other alternative healing methods in health care coverage? >> there clearly are plans in place and i anticipate there will be planned offered in the new exchanges which will give patients a wide variety of

choices. there is likely to be a definition of what is a preventive care plan, insurers are likely to compete based on a more wide range of choices for consumers, some pretty interesting data. their research will look at a variety of alternatives. and homeopathic therapies and choices to better health outcomes at a lower cost. and health-care choices. >> this audience member asks for your thoughts on raising the medicare and other health care

plan eligibility to 70 to keep costs down. >> one of the groups the president has now put in place by executive order and is likely to be convened in the not too distant future is an entitlement commission looking at social security, medicare, medicaid will be part of that. so the rules of those various long-term government programs, the eligibility ages, the benefits provided for cost of the program will be a topic that will be robustly debated and discussed by the entitlement commission and it is appropriate. much of our long term deficit is directly related to the various entitlement programs we have so it is likely to be appropriate

to look at everything from age of entry to what the benefit package looks like, how long people qualify, whether or not there's any contribution based on income and all of those issues will be part of the conversation of the entitlement commission. >> part of the health care reform package is an emphasis on preventing disease and disability resulting not only in significant monetary savings but greatly reduced suffering. fattening foods and sodas increase health care costs yet regulating or taxing them is highly difficult politically. does h h s and the government need to rethink its approach toward regulation and taxation in light of health care reform? >> no question there's a major emphasis in health reform that started as part of the recovery act in prevention of wellness.

in spite of the persistent reluctance of the congressional budget office to school or anything related to prevention and wellness i am a believer it doesn't take much of a rocket scientist to understand that if we're spending $0.70 of every health dollar on chronic disease treatment and $0.08 of every health dollar on prevention rebalancing those underlying causes for chronic disease would save money in the long run. one of the reasons congress put a major first time prevention in the recovery act, the health care costs on two areas. we did pretty well on tobacco and sold last six years when we are at 20%. it hasn't gone down at all. tobacco is the number one

leading cause of preventable disease and death in this country. there is a range dealing with obesity and consideration of taxes of soft drinks, fatty food, what people of beginning to look at. we have put 36 grants out the door in the last two weeks that are going to communities across the country and what works on the ground. we know about tobacco and obesity related strategies that have been effective over time. there has not been a lot of research. so what works at the local level, there is a huge effort

underway as part of the first lady's let's move, eliminating childhood obesity, an important goal looking at all the food shoelaces. kids in cafeterias and vending machines, the secretary of education and agriculture are very much at work for school nutrition standards. part of the bill requires posting of calories of fast food that will be available and easy to read so there will be a lot more information, a lot more policy effort from different directions to get to some of the

underlying causes of chronic diseas >> given your years as state insurance commissioner, to health insurance companies make too much money? >> they make a lot more money than i do. that is a shareholder decision. the disconnect between on one hand arguing for enormous rate increases and overhead costs going forward that will point became the prime example and fourth quarter 2009 profit statement showed a $2.7 billion profit and within ten days, 40%

rate increases for the california market. the ceo got a 50% salary increase. there does seem to be a disconnect which is why i asked the top five health insurers to give us the data. they're justified by health care costs which was the verbal exchange, let us make it transparent and educate the american public what is going on. we haven't gotten that information but i look forward to taking a look at it. >> when will they be in place to implement the health-care reform bill? >> the president will make a decision about naming a new administrator.

what we are doing currently is building a team with the anticipation of a more robust role for medicare and medicaid. a key member of that team who we