Open for Questions: The Home Stretch on Health Reform

Uploaded by whitehouse on 17.03.2010

Jesse Lee: Hey, everybody.
My name is Jesse Lee.
I'm the Online Programs Director here at the White House.
I'm here with Secretary Sebelius,
with the Department of Health and Human Services.
We've done a few of these kind of chats,
trying to take your questions on health reform.
We're obviously getting to the last phases of that
debate and discussion.
And we're happy to kind of have a new audience this time.
We've got, we're on Ustream, we've got readers from Yahoo
news who have been sending us questions in advance.
We've got a ton of great questions from them,
way more than we're going to be able to get to, unfortunately.
But for those who are watching on Ustream,
taking part in the social chat, go ahead and drop your questions
right in the chat.
I'll be keeping up with the chat and pluck some of them to ask
the Secretary throughout.
I'll turn if over to you, if you have anything you want to say up
front and then we'll get into some questions.
Secretary Sebelius: Well, like Jesse, I'm really glad to have a chance to visit
with you today and do the first ever chat on Ustream from here
in the White House.
We're in a historic week and the House is gearing up to have a
vote, up or down vote on health reform,
which hopefully will pass by the end of the week,
and move a bill to the President and a reconciliation bill
over to the Senate.
That's a huge step forward, and this is a good opportunity to
answer some questions.
You know, there are some people who have said why don't we just
start again, you know, why don't we go back from scratch and
figure this out all over again, bring some Republicans
to the table.
And I think the best reason that we're pushing forward,
that the President really wants an up or down vote is not about
a congressional timetable, but there's some real urgency that
I'm hearing all over the country from Americans who are opening
their health insurance bills.
Jesse, you know, a woman in California tells me her bill is
going up 23 percent.
She's got no other options for health care.
A dad stopped me in the airport in Chicago who's paying $30,000
a year because his 11-year-old was born with a heart defect.
He's been totally healthy, but this guy has no other options
for reform.
So the insurance companies are not starting all over again.
And we need, on behalf of the American people,
to finish the job, and to change the insurance rules ones and for
all, and hopefully with a lot of help and support,
Congress will take some action this week and next and we'll
have comprehensive health reform.
Jesse Lee: All right.
I've actually been keeping an eye on the chat for a few
minutes here, as we were getting ready.
We'll start with a kind of hostile comment from Patrica
Philips who said flatly, this bill has nothing in it
to help those in need.
You want to respond to that?
Secretary Sebelius: That's a pretty broad category.
So let me just take need as meaning either can't afford
insurance coverage, can't find insurance coverage,
has no health care right now, and I would say in all of those
categories, there's a lot in this bill for working Americans
who are at the lower end of the income scale.
There's some tax credits, some help to buy health insurance for
the first time ever.
In fact, the biggest health care tax break for working families
ever in the history of this country is part of health reform
for people who have coverage right now and like their plans,
like their doctors.
Not only do they not have to change, but the
congressional budget office says your rates will go down.
More people will be in a market.
There's a lot to limit overhead costs by insurers.
So it's going to be a better deal for you.
Insurance rules will change, so if you're sick or have a
pre-existing condition and need help negotiating with an
insurance company, they won't any longer be able to push you
out of the market, lock you out of the market,
price you out of the market.
A lot of help for seniors.
Less copay for preventive care.
You won't have to put up your own money in order to get a
cancer screening or have a mammogram.
Seniors will get help with overall drug costs.
Help for more kids who want to become doctors and nurses,
more scholarships will be paid.
More people in the work force.
Help for more folks with community health centers.
A lot of health and wellness strategies.
So if you want to stop smoking or lose a little weight or get
some decent preventive care, there's going to be incentives
to do that and help to do that.
So I would say throughout this bill,
there's strategies to have a healthier,
more prosperous nation.
Jesse Lee: All right.
We'll take one more question from the chat before we get into
some Yahoo news questions.
Joe King asked, how are you going to pay for this
health care bill?
Secretary Sebelius: Well, the good news is, Joe, that the bill is
entirely paid for.
The President said from the outset,
he didn't want to do what previous Congresses have done,
which is to pass on benefit and not pay for the bill.
So there's about 470 billion dollars' worth of savings,
money that we're already spending in the system that
isn't going to improve health benefits.
It's redirected, makes Medicare more solvent,
helps close the donut hole, helps pay for some of that
preventive care.
And then there are a couple of ways revenue is raised.
People right now don't pay a Medicare tax on their unearned income.
So if you make all your money off the stock market,
unlike your neighbor or friend who might be collecting a
paycheck and paying Medicare tax,
you don't pay any tax on those stocks.
And for people over, couples over $250,000,
they'll begin paying a Medicare tax on that unearned income
that raises revenue.
We're also collecting a bunch of revenue right now in cracking
down on some of the fraud that's in the Medicare system and
getting that money back and putting it back to solidify
Medicare going forward.
But the bill is fully paid for and it will lower deficits in
the first ten years and in the second ten years.
Jesse Lee: All right.
Let's see.
We'll jump to this one from Yahoo.
It asks about a health czar.
I understand the bill will create an official cabinet
position or health czar to oversee the health plan.
Is it true that the new health czar will have the power to
outlaw anything that is deemed contrary to public health?
My friends believe this bill gives the new health
czar this power.
The czar could ban guns because they kill and injure too many
people and are against the overall well-being
of the nation.
Secretary Sebelius: Let's start with the basic question,
there is no new health czar in the bill.
It doesn't exist, isn't created.
So all the powers that are described as coming with the
health czar also are not part of this bill.
Actually, what's in the bill is a lot of private
market strategies.
Insurance would be provided by private insurance companies,
not by the government.
Private companies would have to play by a new set of rules.
They'd have to compete for their business.
They'd have to pay out so much of their premiums
in medical losses.
They'd have some rate reviews so people will take a look at what
they're charging.
They couldn't any longer lock people out of the market because
of pre-existing conditions.
But no health czar, no new rules that a health czar would have.
Jesse Lee: All right.
Let's see.
Winzette on, signed in through AIM,
asks any reforms to how insurance companies are allowed to work?
Secretary Sebelius: You bet.
Cause that's one of the big features of health insurance reform.
People right now in the small group and individual market,
so if you're self-employed, if you're a farm family with a
couple of employees, if you're running a mom or pop shop,
if you're a consultant, you're often out there on your own in a
battle with an insurance company with your own health history,
your kids' health history.
You don't have any negotiating power.
You don't have any way to lower rates.
And too often companies are monopolies in the marketplace.
So you're really in a loser situation.
This bill helps to create for those people who don't have any
choices, don't have any coverage, a new marketplace.
Private companies would have to compete,
would be set up in a marketplace.
Lower income families would have some help purchasing that insurance.
But no longer could a company drop you if you get sick during
the course of the year and they dropped you at the end of the year.
No longer could a company stop your treatments in the middle of
a chemotherapy regime, which happens each and every day.
You couldn't say to a family, we don't want you because your
child has asthma or diabetes.
No more pre-existing condition for kids or adults.
And they would have to pay out a percentage of their premiums in
medical claims, the so-called medical/loss ratio.
So we'd be able to look at what's coming in the door,
what they're paying the CEOs' salaries, and advertising,
and agents, and make sure that the vast majority of the money
they collect is actually going to help pay for treatments.
Jesse Lee: All right.
I'll rattle off a couple of questions we got from Yahoo
here, which are related.
Candace Roundtree asked, there's already a nursing shortage nationwide.
If the patient load suddenly skyrockets with the passing of
this bill, what are the government's plans to increase
the number of nurses.
And Oscar Jowers in Overland Park, Kansas, says,
Dear Madam Secretary Sebelius, I supported you as the governor of
our great state of Kansas.
I would like to offer you my idea of improving our health
care and that is to address the biggest problem,
which is a lack of doctors.
Secretary Sebelius: Well, I think you're both right.
We have a shortage of health care providers.
But I think it's wrong to think that people right now aren't
accessing health care.
They come through emergency room doors.
They go to community clinics.
They find a way.
They may not have health insurance,
they may not see a medical doctor to get preventive care.
But they're coming into the health care system.
So one of the things the bill does is get people a medical
home, help provide preventive care and wellness care.
So it lowers the burden on some hospitals.
The Recovery Act, which was one of the first bills the President
signed, had a major investment in new health care work force.
More doctors, more nurses, more mental health technicians,
more practitioners.
It almost doubled the number of scholarships we pay off to put
nurses and doctors in underserved areas.
Health reform continues that with a big pipeline for doctors,
nurses, technicians, because we know we're going to need more
folks in the future.
And we're also changes the payment system under Medicare to
make sure that primary care docs and family docs,
who are the biggest need in the system right now,
are paid more appropriately than they are right now.
There's a huge gap between what a specialist can make and what a
primary care doc can make.
And if we're really going to have a healthy America,
we need more medical students to choose primary care
and family care.
Jesse Lee: All right.
We're getting a ton of good questions from chat,
getting through them as fast as we can.
I'll jump right into a tough one, and obviously this is,
you know, something that's been a very huge argument
on both sides.
It's been talked about a lot.
Ryan Bailey asks, I thought the President said that abortion
wasn't going to be in the bill.
Did he lie?
Secretary Sebelius: Absolutely not.
The President said from the outset that he did not want the
health care reform bill to be about abortion,
it needed to be about health care services.
It should not change the status quo on federal dollars paying
for abortion coverage.
It's what the House bill did in language provided by
Congressman Stupak.
It's what the Senate bill does in a slightly different
variation of language provided by Senator Nelson.
There are some members who still say the Senate language is not
what we want, you know, it isn't tough enough,
it doesn't seal off federal funds for abortion.
We have had not only legal scholars take a look at it,
but the Congressional Research Service,
totally nonpartisan research office,
confirmed absolutely that the President is right,
that neither the House or the Senate bill provide federal
funding for abortion.
Recently today, Jesse, as you know,
we had nuns across America, Catholic nuns,
many of whom run hospitals and work in health care systems,
59,000 strong, who, again, endorsed health reform as not
only keeping the current law on abortion policy,
but making it very clear that women who have access to
prenatal care, women who get some support for family services
and potentially for adoption services,
have a much greater likelihood of not choosing abortions in the
first place, whether or not they pay for them out of
their own pocket.
So they feel this is a major step forward.
The Catholic Health Association that runs the Catholic hospitals
across this country and provides care,
has endorsed the health reform bill.
So I think we've got a lot of people who are verifying that
what the President meant is what he said and is
what the bill does.
Jesse Lee: All right.
And, yeah, and I did see that their statement was very --
really passionate.
We've actually got that up, along with a bunch of other
endorsements that came out today at whitehouse.
Another thing you'll find there, actually,
is somebody just dropped in the chat an article that is from the
AP today claiming that this plan would raise premiums.
We've got a nice debunking of that also at the blog.
And, in fact, as you know, premiums will be greatly helped
for families across the country.
So one question we got in the chat was from Carrie Lake,
how and/or will independent age college students be
covered by this bill?
And I'll tie that into another question we got from Yahoo,
which was Vanessa Garrison.
She says, my son Kevin is 23 year old,
and is currently covered under my insurance plan through the
University of Arizona.
He has a pre-existing condition because he had leukemia
when he was two years old.
The Arizona legislature voted last November to allow only
children under 23 years old to be on the University's insurance
plan, but because they voted for this after the enrollment period
ended, they could not implement this new rule until
October 1st of this year.
So the question goes on, and, you know,
obviously these stories are, you know,
everybody's got these personal stories.
But maybe you can talk in general about --
Secretary Sebelius: Sure.
Jesse Lee: how this affects younger people like that.
Secretary Sebelius: Well, I'm the mom of two 20-year-olds,
both of whom are college graduates,
that's very good news.
Both of them lost insurance coverage off our plans when they
graduated from college.
That wasn't such good news.
One of the things that the health reform bill does is allow
kids to stay on their parents' policies until they're 26,
so that's a big step forward for a whole lot of young
people in America.
Recognizing that a lot of people go into the job market or
graduate school and they really don't have an option for
affordable coverage.
If you don't have a parents' policy,
you would be eligible to go into the health insurance exchange,
the new marketplace.
And actually, depending on your wage,
probably have some help buying insurance coverage.
So one way or the other, it's a big step forward for a lot of
young people in America who right now,
particularly with a pre-existing condition,
don't really have any options for affordable coverage and can
actually be in a pretty terrifying situation where they
go without coverage altogether, and they're one accident away
from a lifetime of debt and bankruptcy.
Jesse Lee: Okay.
This is kind of a good philosophical question that's
come up a bunch of times.
And we've heard people argue that, well,
why don't you just do these pieces, be more incremental.
Seth Bassis says, I think we all agree,
health reform is essential.
But why is it being done in such a sweeping manner?
Why can't it be handled in smaller steps with more
Secretary Sebelius: Well, I would say, Seth, there has been more transparency
about this process than any legislative discussion certainly
I can remember in my lifetime.
Hearings have been held in three committees in the House,
in two committees in the Senate, month after month,
covered by C-Span, hours and hours and hours of not only
debating committee and amendments,
but debate on the floor and amendments.
Lots of discussion.
The House passed a sweeping reform bill in full public eye
in November by a majority.
The Senate passed a sweeping health reform bill by a
supermajority just before Christmas.
And now we're going back through the process with an up or down vote.
So I would suggest that this has been a plan that has been discussed.
There have been town hall meetings and outreach meetings
and constituent meetings and phone calls and web chats and
social marketing techniques for the course of the last year.
The reason I think it needs to be comprehensive is the health
care system is complicated.
And certainly the health insurance system is complicated.
And it all ties together.
You can't lower costs unless you get everybody in the market.
You can't get everybody in the market unless you change the
insurance rules that say you can't push people out of the market anymore.
And the underlying issue is we also want a different kind of health system.
We want people to get preventive care and wellness care.
We need more docs and nurses.
So all of those are pieces of a bill that actually implements
over the next ten years.
This is a ten-year strategy to really have a different kind of
health market at the end of the day,
and a healthier America as a result.
Jesse Lee: All right.
Jean Keem, if I'm pronouncing that right, sorry if I'm not,
says, you locked the doors after Obama got elected.
No Republican input whatsoever.
You call this bipartisanship?
Secretary Sebelius: Well, Jean, I would, again, suggest that you go back and
take a look at this dialogue over the past year.
There were months spent in one, just one of those committees,
the Senate Finance Committee, with six senators,
three Republicans and three Democrats at the table,
talking about dozens of ideas, because the Republicans really
wanted to participate.
And certainly the President was enthusiastic about that.
At the end of the day, they walked away from the table.
The House bill and the Senate bill have dozens and dozens of
Republican ideas, selling insurance across state lines,
keeping kids on their parents' policies,
changing some of the rules for insurance companies,
putting people in larger pools.
Those are all areas of great agreement.
At the end of the day, though, there's a fundamental
The Democrats and the President feel very strongly that you need
to change all the insurance rules.
Insurance companies should not be allowed to pick and choose
who gets coverage and who doesn't,
shouldn't be allowed to limit people's insurance based on
pre-existing conditions.
The Republicans don't agree.
They think that should go on.
The Democrats feel at the end of the day that we need to provide
affordable coverage for all Americans,
the 30 million without coverage.
The Republicans disagree.
They say, at the end of the day, if you enacted their version of
reform, there would still be 30 million people without
insurance coverage.
So those are two fundamental differences in approach.
Lots of Republican ideas are at the table.
We hope at the end of the day there will be Republican votes.
But I can guarantee you, this has been a bipartisan discussion
for the last year, and there still are some areas
of disagreement.
But I think there's a lot of agreement that's already
contained in the bills.
Jesse Lee: All right.
And for those in the chat, just go to the link that I just
dropped in there.
You'll find a pretty comprehensive list actually of
some of the Republican ideas that have been incorporated over
the past year or so.
Let's go to question, this came in through Yahoo news from
Louisa McQueeny in Lantana, Florida.
She says, Dear Madam Secretary, our company insures four
employees, consisting of three families and one individual.
Last year Blue Cross collected $52,000 in premiums,
paid out $25,000 in claims, and still raised our deductibles and
premiums up to 19.
2 percent this year.
We desperately need help right now.
How will this help small business with the continuing
increase in premiums each and every year?
Secretary Sebelius: I think that's a great question.
Small businesses are the engine of the economy.
And I think it's one of the reasons the President has said
from the outset, you really can't fix the economy until we
fix health care.
I talk to small business owners every day who not only are
paying exorbitant premiums for less and less coverage,
but who lose good employees because they go down the street,
around the corner, to get better coverage.
So it's a kind of lose-lose situation.
The new marketplace will help.
Larger purchasing pool.
So small business owners will have the same clout and the same
choices right now that members of Congress have.
Bigger pools and insurance companies will have to compete.
You'll have some choice.
I mean, right now most insurance markets are monopolies,
they're not markets.
So in the case that was just described,
Blue Cross Blue Shield is likely to be the only company offering
comprehensive coverage to small groups.
So you don't get to negotiate.
And third, the rules will have to change to participate.
And small business owners will get a specific tax credit to
come back into the marketplace, knowing that often they need
some financial help.
They're trying to do the right thing for themselves and their
employees, but they need some help to do it.
So a major tax break for small business owners who do provide
health coverage.
Jesse Lee: All right.
We've gotten a few questions about the public option.
And I'm going to actually use one that we got from Yahoo.
Randy Chun asked, once passed, 30 to 40 million people will be
signing up for health insurance.
Will this be an immediate windfall for the health
insurance companies?
I'm guessing that insurance companies will automatically get
an infusion of 100 billion dollars of new money.
The public option could have been competitive enough to force
insurance companies to reduce their charges.
What are your plans to drive down charges?
Secretary Sebelius: Well, I think that is a very good question.
Clearly, cost reduction and competition are two of the
focuses of the new marketplace.
And competition in and of itself helps to drive costs down.
They'll have certain kinds of benefit packages that they have
to make sure and have available to folks.
The same way, again, members of Congress have today.
But there will be some competition.
There will be a much bigger marketplace with healthy people
helping to balance the risk.
So that, again, that will help drive down costs to have more
folks who right now often sit on the sidelines because they think
they can wait until they get sick to get coverage.
And we'll have some authority to look at rates and to make sure
that companies are returning 80 percent in a small group market,
75 percent in the individual market,
of what they collect back to customers.
And if they don't, they're going to have to pay some rebates.
So there will be an opportunity to really make sure that at the
end of the day, competition works,
but also that people are not colluding to raise rates together.
They're going to have to pay the vast majority of money collected
back in health benefits.
Jesse Lee: Right.
Phil Hartman literally just this second says,
my insurance will not pay for diagnostic tests.
Can you talk in general a little bit about the preventive care measures?
Secretary Sebelius: You bet.
One of the ways, I think, that most health experts agree that
we have to move in this country to really lower costs in the
long run is move to more prevention and wellness,
not wait until somebody gets sick or has a chronic disease,
and treat that in a very expensive manner,
but look at the underlying causes.
So there's a lot in this measure that really helps people access
primary preventive care.
No more copays for preventive care.
Tests and screenings will actually be encouraged,
not discouraged.
They'll be widely available to folks.
More access to community health centers, where low cost,
high quality preventive care is now available in some
neighborhoods but not every place.
So lowering the costs in the long run really is done by a
healthier population, not waiting until people get sick
and that's been proven strategies in some areas,
we just need to make sure it's available across the country.
Jesse lee: All right.
And yeah, that preventive care has been something that has come
up a lot in this chat.
Secretary Sebelius: You bet.
Jesse Lee: It's come up in a lot of chats we've had.
I know it's something that the President has harped on from the
very beginning on this.
I'm going to take another couple questions that kind of went together.
Virginia Dare asked, she says her and her husband are both on Medicare.
She says, what about my Medicare?
Will I have to pay higher premiums to Medicare?
Tammy Boyer in Tulsa, Oklahoma says,
I don't think that many people are doubting the need for
reform, but they are doubting the ability of government to
make it a reality.
It is a fact that the government ran VA and Medicare very shoddily.
Why didn't the government first take the step to revamp those
programs and get rid of the wasteful spending?
And I think those two questions do kind of tie together in a way.
So do you want to talk about the kind of waste and fraud in
Medicare and how that relates to not cutting benefits?
Secretary Sebelius: Well, I don't think there's any question that comprehensive
reform strengthens the Medicare system.
It helps seniors make sure they get their guaranteed benefits.
It stops paying too much for everything from subsidizing
insurance companies for Medicare advantage plans to overpaying
for various kinds of equipment.
But guaranteed benefits remain totally solid and strong.
And the Medicare trust fund continues for an additional ten years.
It makes the Medicare system more solvent.
Over and above that, we know that too many folks are still
seeing Medicare as a great target for fraud and abuse,
who steal money, steal Medicare numbers,
charge for services that were never delivered,
do a host of things.
So the President has the Attorney General and me going
after those fraudulent activities.
We've had pretty good success so far, almost 4 billion dollars,
just in this administration has been collected back in the term
of indictments or settlements with drug companies and medical device.
We've had close to 100 convictions.
People are going to prison.
But it also sends a very strong signal that we're serious about this.
That money goes back to make the Medicare system more sound.
And I would say overall, both the VA system and the Medicare
system have worked very well for millions and millions and
millions of Americans.
Can they improve?
You bet.
And we're taking that very seriously.
But I can't imagine a country today without either a VA system
for our vets, or Medicare for our seniors and disabled Americans.
Jesse lee: All right.
Secretary Sebelius: I probably can do one more.
Jesse Lee: Yeah, I was about to say exactly that.
Well, so this is a question on children with pre-existing conditions.
Melanie Lynnette Powell, Nelson, Arkansas,
if the health care reform packet's passed,
will a child such as mine be able to get health insurance?
My son is 8 months old and has been diagnosed as having
sickle cell disease.
My husband and I are penalized for working so we are over
income for all state-operated insurance programs.
And maybe you could just in closing kind of talk about how
this addresses middle class people that are not on,
you know, Medicaid and those programs, but still
can't quite afford to take care of insurance themselves.
Secretary Sebelius: Well, first of all, one of the changes that hits right away
in 2010, if this bill passes, is insurance companies can no
longer limit children with pre-existing conditions.
So that barrier ceases to exist.
In the country right now, if you're poor enough,
you qualify for government-sponsored insurance
for your children and/or yourself.
If you're older or disabled, you qualify for government help with insurance.
The people caught in the middle are working families who often
don't qualify, don't have leverage in the marketplace,
don't have help paying for premiums.
So new marketplace helps lower costs.
New bargaining power helps lower costs.
Changing insurance rules helps increase choices,
and depending on the income level,
families up to 400 percent of poverty, which is about $88,000
for a family of four, gets some specific financial help to
buy into the pool.
Small business owners, who are currently struggling and can't
figure out if they can continue to offer coverage,
get some help to stay in the insurance pool.
So there's a lot of help.
The biggest tax cut ever for middle class families directly
related to health care is contained in this bill.
And that's one of the huge issues moving forward.
Jesse Lee: All right.
Well, I want to thank you so much for sticking around some
extra time for us.
Secretary Sebelius: Sure.
And hi to my kids' friends.
Jesse Lee: Exactly.
And by the way, hi to my mom whose birthday is today.
Secretary Sebelius: Happy Saint Patrick's Day.
Jesse Lee: Exactly.
But everybody who's watching, please keep an eye on our Ustream channel.
Keep an eye on
We have a lot of chats like this.
We have a lot of kind of great information,
whether it's on health reform or any other issue you're concerned about.
And we look forward to seeing you next time.