Women’s Health Town Hall

Mayra Alvarez:
Good morning, everyone. Audience Members:
Good morning. Mayra Alvarez:
My name is Mayra Alvarez, and I’m Director of Public
Health Policy in the Office of Health Reform at the Department
of Health and Human Services. And on behalf of the Department
and the Administration, it is my pleasure to
welcome you to our Town Hall on Women’s Health. We’d like to thank the White
House for helping us to organize and host this important event,
and especially thank those of you here with us in the room,
and the many online viewers and social media participants and
followers for joining us via Twitter and Facebook. Just to make sure we’re
all on the same page, I want to remind participants
and viewers to post questions on Twitter using the
hashtag WomensHealth. For any questions we are
unable to address live today, we will try to follow up online
after the event to make sure you get the information you need. So, each of us participating
in this town hall today has a special woman in our lives. For this woman, today’s
extra special for me. I get to give thanks to a woman
who brought me into this world. My mother was key to
my health as a child, and even to this day her
support and her love are vital to my well-being. And for all of us, whether it’s
our mother, our grandmother, our sister, or our friend,
women are critical to our health and well-being. The women we know and love
keep up with appointments, inquire about how we’re
feeling, and look after us, keeping families and
communities healthy. Today’s town hall will give us
the opportunity to discuss with you how as an administration
we’re working to make healthcare more affordable and accessible
to millions of women and all Americans as we implement
the Affordable Care Act. The Affordable Care Act is a
healthcare law that includes groundbreaking policies
to improve the health and well-being of women in
communities across the nation. And we hope that this event can
help continue the conversation around the many benefits the
Affordable Care Act overs right now for women and
their families. To help us engage in this
important discussion, we have with us a distinguished
group of panelists. We have Judy Waxman,
Vice President at the National Women’s Law Center. Caya Lewis, Counselor to
the Secretary of Health and Human Services. We have Kathleen Sebelius, the
Secretary of the Department of Health and Human Services. Cecilia Munoz, Director of
the White House Domestic Policy Council. And with us from the media, we
have special guests joining us: Margarita Bertsos,
Health Editor of Redbook, a popular woman’s magazine
reaching 8 million women across the country. And Kelly Wallace from iVillage,
a popular social media site that reaches 30 million unique
visitors each month and a newsletter that reaches 5
million women per month. Thank you all for being here. A panel of experts, but most
of all a panel of individuals dedicated to improving
the health of women and their families. Before we begin, let’s remind
ourselves why we’re here and kick things off with a video. At HHS, we recently launched an
initiative to showcase stories of Americans who know firsthand
the new programs, benefits, and rights under the
healthcare law and how it impacts their life. We call the initiative “MyCare”. You know the saying “A picture
is worth a thousand words.” ? Well, the video
is worth even more. The video we’re about to share
tells a story of Robyn and her son Jax of Maryland. ♪♪ Robyn M:
I’m healthy. I have great health
insurance through my job. Never really thought
that this bill, this law, would really affect
me quite as much, and then I got
pregnant with Jax. Jax is a twin. He and his brother
were born in August. In my second trimester,
I found out that Jax was diagnosed with Trisomy 22,
which is a genetic disorder called Cat Eye Syndrome. And along with that, along with
several other possibilities, he had a heart defect. They were born at 36
weeks with a C-section, and Jax immediately
went to the NICU, and he spent three weeks there. In the three weeks time we found
out a lot of things weren’t going to be something we had
to worry about that was part of this genetic disorder, but the
problems with his heart were more severe than they thought. His heart is actually on
the wrong side of his body. His intestines are backwards. He may have vision problems. He might have
cognitive problems. But the heart was the most
concerning thing at that time. After three weeks, they sent him
home to grow and develop so he could be a little bit
stronger for his surgery that he would need. They sent home a fairly
listless kind of blue baby. We took him to a lot of
doctors’ appointments. It was very stressful. We had to make sure he
wouldn’t cry too much, or his heart would stop. We’d have to call 911. Kathleen Sebelius:
Oh, my. Robyn M:
And we have his twin and two-year-old sister, as well. So it was a very stressful time. In November we took
him for his surgery. He responded immediately. He came out a pink baby. He moved a lot. It was an amazing difference. The first day in the
NICU was over $150,000. If he in five months used up
the lifetime limit for him, my family would be in
really dire straits. He is going to have to
have follow-up visits, potentially follow-up surgeries. We would move mountains to pay
for healthcare for this child. We’re very glad not to have to. ♪♪ Mayra Alvarez:
That’s quite a story. We are fortunate to have Robyn
and Jax here with us today. So, thank you,
Robyn, for being here. (applause) This is what
today is all about. It’s about Robyn. It’s about Jax. It’s about the millions of
others across the country that have been touched by this law
in some way, hearing from women, talking to women, and having
that conversation about what this law means, not on
paper, but in real life. And our next speaker knows a
thing or two about working with people across the country to
help them feel more connected to this administration. Here to help welcome us to
the White House is Tina Tchen, Assistant to the President and
Chief of Staff to the First Lady, and the Executive Director
of the White House Council on Women and Girls. Tina most recently served
as Deputy Assistant to the President and Director of the
Office of Public Engagement. So she definitely knows a
thing or two about connecting with people. Today we’re lucky
to have her join us. Tina? (applause) Tina Tchen:
Oh, well, thank you, Mayra. And as you talked about your
mom in your opening remarks, I hear that actually today is
the anniversary of your birth, it’s your birthday. So happy birthday to Mayra. (applause) And, Robyn,
welcome to the White House. Welcome all of you
to the White House. I have to sort of recover
a little bit from hearing your story. Thank you for
sharing your story, because it’s so important
in getting this message out. And thank you all
for being here, and we really do want to
welcome you to the White House. I’m delighted to be here
and with both my hats on, as Mayra described, both as
Chief of Staff to First Lady Michelle Obama and as Executive
Director of the White House Council on Women and Girls. A little bit about the
Council on Women and Girls, for those of you who
don’t know about it, it was created by the
President by executive order in March of 2009. It consists of every part
of the federal government, so all of the federal agencies,
all of the major White House offices. And as the President said on the
day that he created the council, his intent was to maybe sure
that every part of the federal government pays attention to
the needs of women and girls, and what our agencies do in
their everyday work and then in the major initiatives that he
has been promoting throughout our administration. So in those three
years, I’m proud to say, we have done things
like support equal pay. The first bill the President
signed into law was a Lily Ledbetter Fair Pay Act. And we’ve just spent this
week supporting passage of the Paycheck Fairness Act, which
we’re going to keep working on. We have our Race to the Top
program that has promoted STEM education for girls. We have the first ever White
House Advisor on Violence Against Women who has been
promoting initiatives across the federal government to fight
against violence against women, and we’re going to continue
also to keep fighting for the Violence Against Women Act,
now pending in congress. And we’ve made historic
investments in Head Start, tax credits to working families,
support for women entrepreneurs. But today’s topic is something
we’ve also devoted a tremendous amount of time because
of its importance, because it touches the lives of
so many women and their families across the country. And that is healthcare for women
and the President’s historic achievement and passage of
the Affordable Care Act. And we’re going to be discussing
the many ways today in which the Affordable Care Act has really
touched the lives of women and girls, their families
across the country. And so one of the President’s
really strongest supporters in this, one of the great
spokespersons for women and girls in our country
is our next speaker, who I’m delighted to
welcome to the podium. It’s a dear friend of mine who
is the Chair of the Council on Women and Girls and Senior
Advisor to the President, Valerie Jarrett. (applause) Valerie Jarrett:
Thank you, Tina, and good morning, everybody. Happy birthday, Mayra. We’re delighted to have
you and everyone here. One of the real advantages of
the White House is our ability to convene. And our Office of Public
Engagement that Tina used to run and is under my portfolio,
our whole purpose is to reach out broadly around the country
and make sure that everybody is engaged and informed and
has a right to participate in our dialogue. And so I want to look around
this room and I see all of these amazing women and a couple of
brave men who came in as well. (laughter) You’re welcome. We’re glad to have you. So welcome everyone on
behalf the President. And thank you,
Secretary Sebelius, for coming over and helping
us organize this, as well. As many of you know,
I’ve known the President just a little while. It’s now 21 years. I was just a child when we met. (laughter) But over those 21 years, I’ve been so struck by how he
gets the issues that are so important to us. And not just as a politician
and now as the President of the United States, but as a person
who grew up with a single mom, and he watched the
challenges that she faced, who lived with his grandparents
for a while who helped raised him, the father of these two
incredible young daughters, and married to this
terrific woman, and now living in a
household, as he describes it, where he’s completely surrounded
by women: His daughters, his wife, his mother-in-law. All he’s got is Beau,
really, and he mentions that quite often. (laughter) But I think it
really has informed his decision making. And he is the first to mention
that one of the first moments in his life was when his daughter
Sasha as a baby was rushed to the hospital extremely ill. And he said there just was
nothing more painful to him. Or watching his mother die at a
very young age before she had a chance to even know her
grandchildren or before she had a chance to watch his
ascension to be President of the United States. And so he has been struck by
these issues at a very human and deep level. And I think that that’s so
important to have a president who comes to the table with an
appreciation for what and how important women’s
health is for us. And so I think, as we all know,
the Affordable Care Act has been a tremendous, tremendous piece
of legislation that is helping women and families
all across our country. And what the President believes
is that quality healthcare is not a luxury. And it can’t come
with a luxury price tag, not when so many people are
at this make or break moment, those in the middle class and
those trying to get into the middle class. The President knows that there
are folks around our country like Joyce Morgan of
Charleston, South Carolina. Thanks to the
Affordable Care Act, Joyce has a security that comes
with knowing that her 23 year old, her daughter Emma,
can stay on her own health plan until she turns 26. Emma, along with 2.5
million young adults, who now receive health insurance
through this provision, and a couple of years ago
right after it was passed and implemented, my own daughter,
Laura, finished school, and she had a gap between the
time she finished school and the time she started work, and she
was searching through all of the possibilities for healthcare. And I said, Laura, have you
looked at the provisions of the Affordable Care Act? You can now come
on my insurance. And I can tell you, I certainly
slept better knowing that she was able to join my insurance
and wasn’t forced to take on those exorbitant costs if she
had had to pursue her own. And of course that’s just one
of the many provisions of the Affordable Care Act that
helps women and girls. But not all women have equal
access to healthcare or similar healthcare outcomes. Low income women and women
from racial and ethnic minority populations often have
higher rates of disease, fewer treatment options,
and reduced access to care. They are also less likely to
have health insurance or usual sources of care for
populations as a whole. Latinos, for example,
are twice as likely to be diagnosed with cervical cancer. And while breast cancer
diagnosis is diagnosed only 10% less frequently in African
American women than white women, African American women are 36%
more likely to actually die from the disease. This law, as you all know,
is actually making a difference in people’s lives. Thanks to the
Affordable Care Act, more young people
have health insurance, more community health centers
are treating more patients, more doctors are treating
people who are living in underserved areas. From screening for cervical
cancer to gestational diabetes, and, yes, contraception, the
President has fought for access to care and services that will
protect women and families and build a healthier nation. When it’s fully implemented,
it will do even more. But we know it won’t reach
its full potential without your help. And so I want to thank you for
the work that you do each and every day, for being
with us here today, and I wouldn’t to encourage you
to raise your voices in your communities to ensure
that Americans know about their rights. It’s so important that people
know what’s available to them and the benefits under this law
so that they can live longer and of course live healthier. So thank you for being here. And now I have the distinct
honor of introducing to you the Head of Domestic Policy for
President Obama, Cecilia Munoz, who will come up and give
also some additional remarks. Thank you. (applause) Cecilia Munoz:
Thank you, Valerie. I’m going to be very brief, but
welcome also to the White House. We’re really so
excited to have you here. This is so important for all
of the reasons that Valerie and Tina have talked about. It’s also, I think,
certainly for me, I know I’m speaking
for the panel, I suspect I speak for the
room, this is personal, right. This is about advancing health. This is about making sure
people have access to coverage. This is about making sure
when you have coverage, you get the services you need
and they can be affordable. All of these things have
been accomplished by the Affordable Care Act. And I say this as a —
as a policy wonk, right, I’m responsible for domestic
policy in the White House, I say this as a woman,
as a mother of daughters, as the daughter of a woman
who fought breast cancer for 18 years. This is personal. We know that as women we are
often sort of the gateways to healthcare and coverage
and, as you heard, making the appointments, making
sure everybody in the family gets taken care of. We worry about affordability. My mother during her illness
worried a lot about the women who didn’t have the
coverage that she had, the women that she
saw getting treated, the women that she knew weren’t
getting treated because they didn’t have access to the
coverage that she had, which helped extend both
the length and the quality of her life. This is personal. And what we’ve accomplished in
the Affordable Care Act allows us not just to treat
conditions once they happen, but to get ahead of conditions
that disproportionately affect women of color,
for example, like diabetes, like cardiovascular disease,
like certain forms of cancer. The fact that for people with
coverage preventive care is available without co-pays
and co-insurance is huge. It allows us to get out in front
of these conditions before they become emergencies, before
they become more costly, not just in economic terms,
but in terms of how they affect our lives. So, as Valerie said,
we’re so glad you’re here, because this is personal. It’s important. It’s important to
our well-being. It’s important to the
country’s well-being. But access to preventive care
and the other kinds of services that are available under the
Affordable Care Act is only going to be meaningful if
people know that it’s there. The fact that you don’t have to
struggle with lifetime limits through your health
insurance coverage, people need to know that
that protection is there. The fact that people with
preexisting conditions have access to care that you can’t
discriminate against children with preexisting conditions will
matter the most and have the most impact if people know that
those protections are there. So that’s why we’re here. That’s why we’re having
this conversation. We are so excited to have you
here and so really excited about the important impacts that this
law is already having and the impacts which are on the way. And with that, I have the great
privilege of introducing someone that I love working with. We are so lucky to have her
as a Secretary of Health and Human Services. She’s someone who is a fighter
and has been throughout her career, not just for healthcare
but for a whole array of things which move this country forward. Secretary Kathleen Sebelius. (applause) Kathleen Sebelius:
Well, good morning,
everybody, and welcome. I think it’s great that Mayra
had a birthday party for herself and invited this dazzling group. (laughter) And I’m really pleased
to join Valerie and Tina and Cecilia in welcoming
all of you today. I think we’re going to have
a great panel discussion. But I just wanted to frame a
little bit of the discussion that we’re going to have
about some of the reason that we’re all here. I don’t think there’s any
question that the Affordable Care Act is the most important
women’s health law in at least 50 years since Medicare
and Medicaid were passed. Cecilia just went over
some of the new benefits, but I think it’s also really
important to understand what a difference this can make for
women in the insurance market. What we know is that women at
some point in our lifetimes are likely to be in a situation
where we’re out purchasing insurance on our own. Between jobs, after
retirement, losing a spouse, we’re going to be
in that market. And in the past, that has been
a devastating market for women to be in. First, you had to kind of get
in the door of an insurance company, and that wasn’t easy. Insurance companies could deny
coverage to women for anything from being a breast cancer
survivor, like Cecilia’s mom, to delivering a
baby by C-section, which I have done and a
number of us have done, to being a victim of
domestic violence. That would put you
outside the market. They could just deny
coverage all together. Now, if you were
young and healthy, insurers could still charge you
up to 50% more — that’s still going on around the country
— up to 50% more for the same coverage that your male
colleagues were able to get. And that meant just being born a
women was in insurance parlance a preexisting condition. Being a woman was already
a black mark against you. One study, I think it’s
Judy’s study, actually, and she may be talking
about it later, found that that disparity, that
extra money charged to women, cost a billion dollars a year. That’s money out of our pockets
that could be feeding our kids and paying for rent
and buying groceries. Then, adding insult to injury,
even if you could find coverage and afford that coverage, there
was a good chance that the plans didn’t match your needs. What we know is about 50% of the
plans in the individual market, those women buying
coverage on their own, don’t even cover
maternity coverage. Many of them lack any kind of
prescription drug coverage. They don’t cover
mental health services. So you were paying 50% more and
then paying 100% out-of-pocket for the services
you really need. And finally, you pay extra
money, you get the coverage, you pay out-of-pocket,
you’re all set to go, right? Not so fast. Because insurance companies, up
until the affordable care law was passed, could dump you out
of the market if they found a technical mistake in your form. And what we found,
unfortunately, were patterns of real abuse. Companies targeting breast
cancer survivors and finding in their algorithms how to go back
through their forms and try and determine if there was any
reason the so-called recision really meant you were
thrown out of the market, even if you were paying your
premiums on a regular basis. So it was not a market that
was very women friendly. The deck was stacked against
really all Americans in that small group and
individual market, but especially against women. And what we’ve done with the
Affordable Care Act is put some basic fairness in place. First, by 2014, it will be
illegal to discriminate against anyone for preexisting
health conditions. It’s already, as Robyn knows,
illegal to dump kids out of an insurance policy because
of a preexisting condition. That went into place right away. But by 2014, that will
apply across the board. Secondly, it’s illegal, and
will be in the new market, to charge women more than men
simply because of their gender. That’s a huge step forward
for women in this country. We will no longer be our
preexisting health condition, and that day is long overdue. Through the coverage that
we buy will cover our needs. What an interesting idea that
you will have an insurance policy which actually looks
at women’s health needs. And it’s not just
our department. It is really the institute of
medicine that was charged with looking at the gaps in health
coverage and including now the services, preventive services,
contraception coverage, maternity care. So when you buy an
insurance policy, you will have some confidence
that it really does cover your health needs. And fourth, there’s a
Patient Bill of Rights. It stops insurers from dumping
people out of the market. That’s already the law today. It makes sure that there are
no longer lifetime limits, as you just heard in the
compelling video we saw. It doesn’t affect
a lot of people, but the people it affects,
it’s a life or death situation. If you run out of coverage
in the midst of an expensive chemotherapy treatment,
or when your child is born needing follow-up care,
you can really be in a terrible situation. So I’ve had a great
opportunity — excuse me, and how do you like
that technique? (laughter) Pretty good, huh? Chuck Todd didn’t
get it right away, but you all know how
to sneeze and cough. I’ve had a great opportunity in
the last few months to travel around the country and have the
living room conversations that you just saw about today. We’ve been talking to women
throughout the country about the Affordable Care Act and how
this law is already impacting their lives. I’ve met mothers
of young children, moms who can now keep their
children on their health plan, as Valerie just described
with her daughter Laura, up until the age of 26. Women who are battling
diseases like breast cancer, whose lives literally have been
saved when they became part of the preexisting condition plan,
which now covers about 60,000 people across this country
who had absolutely no health insurance because of
their health condition, and now are alive based on the
treatment they are getting. Now, what the law
meant for them, for all of us in this room and
for women across the country, is peace of mind. Peace of mind that no matter
what the circumstance is, whether they need insurance
because they get divorced, or want to go out and be
an entrepreneur and start a business, or finish school,
or because they are a blogger or free-lance journalist,
care will be there, affordable prices will be there,
and coverage will be there that you need. And that’s really
what the law is about. Now, we’re going to open up
for questions in a minute, but before we do, I want to
introduce another person who was featured in the MyCare
Initiative, Helen Ran. Helen is a senior joining
us today from Philadelphia. I had the privilege of being
with Helen a few months ago, and she does have
a wonderful story. So let’s take a
look at Helen Care. Helen R:
I do have more peace of mind with the healthcare reform. Helen’s doctor:
I’m going to get
some good numbers, right, perfect? Helen R:
Hopefully, yes. Helen’s doctor:
All right. Helen R:
That act is helping
me as a senior, because I know that I can
get certain screenings and medications without
having to break the bank. And I can go ahead and
get my examinations, screenings on time, and get my
evaluations and results so that I can take care of any
illness that might be arising. Helen’s doctor:
I’ve seen the availability of some preventive care that
patients maybe couldn’t otherwise afford or even
thought were important, such as mammograms,
flu shots, colonoscopes. All those things play an
important role in keeping people healthy. Helen R:
Hey. Helen’s grandson:
How are you? Helen R:
All right. And you? Helen’s relative:
Hi, mom-mom. Helen R:
Hi. I am a grandmother who is
trying to assist a grandson with his education. I take seven
different medications. Getting the donut hole closed,
that gives me a little more money in my pocket. Patrice, I have a
message for you. I work at a senior center. I have been working there
now for nearly six years. I do get energized at work. So you’ve been having
trouble with your back. How you feeling? I have to set up workshops
and programs that will help them with their health and wellness. So many of them are so
much older than I am, and their spirits are so high. When I see that, it picks me up. If it weren’t for
healthcare reform, many of our seniors
would not get to a doctor or get mammograms. It is expensive for
us to keep good health. Healthcare reform will help us
so much to know that we can get certain things at a
cheaper cost, a lower cost, or no cost at all. The health care law
is about people like me. It’s Helen Care. Kathleen Sebelius:
Well, my comments
were principally about the private market
and what’s changing, but Medicare is also changing. And Medicare is a
women’s health program. The majority of beneficiaries
in Medicare are women. And as you work your
way up the age ladder, more and more of the
beneficiaries are women. So having preventive
services without co-pays, having the opportunity to
do annual wellness visits, which were never a part of
the Medicare program before, closing the donut hole, which
is a key part of Medicare, have really been part of
the Affordable Care Act, to strengthen Medicare for
now and into the future. So now lets get to
our conversation. Mayra Alvarez:
Thank you, Madam Secretary. We are all thankful as an
employee of the Department of Health and Human Services, we’re
all thankful for your leadership and dedication on this
issue and so many others. So, we’ve had a great welcome
from some fabulous women leaders from the Obama Administration,
but now it’s time to hear from you. Like Cecilia said, the important
benefits and rights and protections made possible by the
Affordable Care Act really only matter if the American women
know about what’s available to them now and what’s
coming down in the future. So I want to get this
conversation started. This is a town hall. And we’re going to kick it off
by going to our distinguished panel and open it up
to our media guests. Margarita, can you give us a
question from your audience at Redbook? Margarita Bertsos:
Absolutely. Thank you. So I think one of the things
that we’re dealing with as journalist is that
the law seems to be — Audience Member:
Can’t hear you. Margarita Bertsos:
Sorry. Thank you. One of the things we’re dealing
with as journalists who want to communicate to our readers
what’s available to them is that the law is affecting different
groups of people in different ways at different times. And so I think that, you know,
similarly to a picture being worth 1,000 words, a
headline is worth 1,000 words. But we don’t know
what the headline is, because it seems
like every, you know, different subsets of a
population will have a different headline. So, can you help us understand
a little bit what we need to be communicating to readers? Mayra Alvarez:
Absolutely. I think one of the great
benefits of having media participants as part of this
panel is to give us a better insight of what people need
to hear and in what format. One of our great initiatives
is the MyCare Initiative. Secretary Sebelius,
do you want to take that? Kathleen Sebelius:
Sure. I’ll give it a stab
and others can join in. I think one of the things
about the Affordable Care Act, because it is a very significant
and comprehensive piece of legislation, it is
phased in over time. And in part, that’s to
get the new markets right. A number of the benefits
went into effect right away. Young adults staying on
their parents’ plan was a 2010 advancement. Children not being denied
coverage because of preexisting health condition went
into effect right away. Some of the Patient
Protection Act, so no recessions any longer. Companies can’t dump
you out of the market. No lifetime limits went
into effect right away. So the changes around Medicare
went into effect right away. Annual wellness visit, gradual
closing of the donut hole, which this year is a 50%
discount for seniors on the drugs they are purchasing once
they hit that coverage gap. Those are in effect. And what is coming in 2014
is really the new markets, the state-based health
markets, called exchanges, where people will be able
to purchase coverage in a larger pool. You don’t have to join an
organization or do anything. You will just be
eligible to do that. And have competitive prices and
some knowledge of the fact that all insurers will not be able
to pick and choose based on preexisting health conditions. The best, and we’ve talked about
this a little bit, Margarita, but everyone needs to know
there is a very good website at healthcare.gov,
which gives a timeline for this comprehensive bill. What’s in place
now, what’s coming, and really what impacts an
individual and her family. A lot of us may be caring
for an older parent. So you need to know about the
Medicare benefits along with what might affect you. Healthcare.gov also has right
now a first of its kind snapshot of the current insurance market. So if you are purchasing
coverage on your own or a small business owner trying to find
coverage for you and your employees, there is an
ability to put in a ZIP Code, answer a couple of
health questions, and get in place side-by-side
every product that’s in the market now and what they are
charging for that insurance. So in the short-term,
there’s that availability. Two other things which are
in place right now are this preexisting condition pool,
which operates in every state around the country. So people who have been
denied coverage because of a preexisting health condition
didn’t have any other option now have an option
for some coverage. And small business owners, and a
lot of women are small business owners, who are looking for
coverage for their employees, there are tax credits that began
to be effective starting in 2010 to purchase employee coverage to
kind of stabilize that market. So a lot has happened already,
and a lot more is coming in 2014. Mayra Alvarez:
Absolutely. And I think if you think about
just the couple of minutes that the Secretary spoke,
she named small businesses, she named preventive
services, she talked about lifetime limits. Each different issue that speaks
loudly to certain populations, certain segments of
your readers, Margarita, and I think if you’re talking
to someone about business and women, or if you’re talking
to someone about families and women, I think there’s a
different aspect of the law that can speak more clearly
to those audiences. Kelly, do you have one
from your audience? Kelly Wallace:
Do I have one? (laughter) We had
so many questions, many of them from our
iVoices on iVillage. These are our real moms and
dads who contribute videos to iVillage on the issues they care
about most, and I love them. Some of them gave three
or four-part questions. So I won’t ask them all, but
this is one from Beth Ingleman, and she’s a single mom. I think she has a
six-year-old in Chicago. And she wanted to know,
how is the new health insurance bill going to affect
my family’s premiums? Will they go up? I think that’s a question
some people have been asking. And she also asked, how will
the health insurance bill help promote preventative
care for children? Mayra Alvarez:
That’s a great question. I think a lot of people
want to know the details. Judy, you represent an
organization that speaks the voice of millions of women
across the country here in D.C. every day. What do you tell women that
come to you to ask those similar questions? Judy Waxman:
Well, many of the
points that have been made already, of course, are ones
that we talk about quite a lot. And some of the things that I
think a good answer may be for Beth would be that there are
provisions in the law that will make insurance companies more
accountable and more transparent in the premiums
that they charge. It’s kind of a little
known part, I think, but I will say it is
already having an effect. Our own insurance at my
organization in the past has gone up 10% a year and this
year actually went down. And when we asked them —
(applause) I don’t expect that to happen every year, I got to
say, but we did ask, you know, our insurance broker and
company, why is that? Although, we had
strong suspicions why. And they did say it was
the Affordable Care Act. So, and it is because the
companies now have to limit how much they can use of the
premium for profits and for administrative costs, and they
have to be transparent about it. And that is a really important
step for all of us now and, of course, way into the future. Kelly Wallace:
Absolutely, great. And then the second question
about what’s in there in terms of preventative care for
children in the healthcare Affordable Care Act? Kathleen Sebelius:
Well, I think it starts with the fact that it’s now illegal
for companies to deny coverage to children. That was never the
case in the past, and companies could
do one of two things. They could either just say, we
won’t cover your child at all if, like Jax, he was born with
a preexisting health condition, he could be written out
of the family health plan. Or we won’t cover the
things that Jax needs. So we won’t cover
— we’ll cover Jax, but not his heart and not his —
that was, again, totally legal. It’s called medical
underwriting. You just eliminate
conditions that you cover. That will no longer be legal. So you start with
broader coverage. And then there is a directive
in the bill that in addition to looking at the recommended
preventive services for women that we also look to the
listing of preventive services for children. And those become automatically
updated and part of what is kind of an essential benefit
package for an insurance plan. So you can be confident as a
parent that if you buy health insurance, your child will be
covered and that the preventive services from childhood vaccines
to recommended treatments will be not only included but
updated on a regular basis. As the science changes,
as the science improves, that is automatically added
to that benefit package. And again, don’t have
to read the fine print. Don’t have to go to page 32 and
look through the paragraphs to see what it really
says about coverage. There’s some confidence there
that the insurance policies actually will cover and be
updated in that coverage. Mayra Alvarez:
Absolutely. I think, you know, the coverage
of preventive services without cost sharing requirements
speaks to women and families across the country. I mean, it’s a tough
economy out there. Trying to figure out if you’re
going to pay a $40 co-pay for a mammogram or $40 for groceries
for your family, I mean, it’s a decision that a lot of
families have to face today. Doing away with that cost
sharing requirement really speaks loudly to some of our
most vulnerable women and families across the country. You know, Valerie this morning
talked about how Latinos across the country have cervical
cancer at a rate twice the general population. And African American women are
dying from breast cancer even more than the diagnoses
are happening, right? That’s because they are not
going to the doctor to diagnose these cancers early
enough to catch them, to get the treatment they
need to live healthy lives. The Affordable Care Act, doing
away with those cost sharing requirements, is going to
make that much more possible. So let’s continue the
conversation and open it up to our great audience. Do we have any questions? (laughter) A few, okay. I’m going to take
it to the back. Keith, can we ask her
to come to the front? Keith:
Yes, please. Kathleen Sebelius:
It’s also Keith’s birthday. Mayra Alvarez:
It is. (laughter) Kathleen Sebelius:
One of the few
wise men who is here. (laughter) Alana Elias Kornfeld:
Hi. Hi, thank you so much. My name is Alana Elias Kornfeld. I’m the Executive Health
Editor at Huffington Post. My question is about integrative
medicine and the place that integrative medicine has in the
Affordable Care Act or any of your other initiatives and how
that would specifically impact women’s health? Thanks. Mayra Alvarez:
I think. Oh, go ahead. Caya Lewis:
I was just going to say, can you tell us exactly what you
mean by integrative medicine, because I know people
use it different ways? Then that will help us. Alana Elias Kornfeld:
Sure. Treatments that don’t require
surgery or drugs, perhaps. Preventative care in the way of
nutrition, lifestyle changes, the promotion of better sleep,
and acupuncture, homeopathy, energy orac. I mean, yeah. Judy Waxman:
Well, I can take a stab at that, and happy to have
others jump in. But the preventive health
services that will now be required to be in
everybody’s plan, this is whether you are getting
new coverage or you have existing coverage over time,
every plan will have to cover a long list of preventive
services without cost sharing, as we have said. So some of the services we’ve
already mentioned and they are what I’ll say more traditional,
like mammograms and Pap smears. But there’s also,
not everything you named, but there also is
nutrition counseling. There is also going to be
starting in August counseling for domestic violence. An attempt to start moving
towards requiring coverage of all these kinds of discussions
and — breast feeding pumps and counseling. Those kind of things that will
move us in the direction of looking at people’s health
rather than just their sickness. So it doesn’t cover everything,
but of course over time that list will be evaluated,
as the Secretary said. New evidence will
help that list expand. And I think this law does make a
big shift in our thinking about what healthcare should be. Should it just be looking at
sickness or should it also be making us more healthy? Kathleen Sebelius: I would
say then on a state-by-state basis — as you know, a lot of
states have adopted a wide range of alternative treatments and
methodologies that they include in insurance packages
others haven’t. And so as states put together
their own state-based exchange, those benefits will also
be available to be added. So it may vary a bit depending
on the discussion and the dialogue in that state,
but those decisions are kind of wide open until 2014. And in some of the therapies
that you described, probably more appropriate
at the state level, what Judy is describing is kind
of the national framework which sets a floor for coverage,
and then there will be some variation depending on those
discussions at the state level. Mayra Alvarez:
And you raise a
great point, though. I mean, when you
talk about health, we all define it differently. When you talk about healthcare,
we approach it differently. One of the main components of
the Affordable Care Act is the creation of the National
Prevention Council, of which 17 departments,
federal agencies, offices, comprises council and talk about
prevention and public health and health promotion. And one of the specific charges
is to look at integrative medicine and to
discuss that issue. We have an advisory group of
national experts on public health, two of which are
specifically looking at integrative medicine as
their top areas of research. So we’re excited to have that
conversation and seeing where we can go in the future with it. Okay, let’s do the red jacket. Kelly Wallace:
Lots of questions. Linda Murray:
Hi. My name is Linda Murray,
and I’m the Editor-In Chief of BabyCenter, which is an online
resource for pregnant women and new moms. Our question for moms is,
what do you mean by affordable? Is there a target
for affordable? We had several moms tell us
family of four they are paying $1,000, sometimes more, for the
health care for their family. That exceeds, in some
cases, their housing costs. So, is there a target
for affordable, and what does that mean? Mayra Alvarez:
You want to go
ahead and take it? Cecilia Munoz:
I’ll start. Mayra Alvarez:
Yeah, go for it. Cecilia Munoz:
So, I’ll start. I mean, if you follow the
debate closely, I mean we all, we’re very deeply engaged in
it, you hear the President say multiple times that
among the many goals, but prominent goal of
the Affordable Care Act, is to bring the cost curve down. Right? We’ve been on the wrong
trajectory for a long time of cost escalating. And so the panoply of
things that you’ve heard about are really designed to
bring the cost curve in the other direction. So while there isn’t
a specific target, each of the policies that you’ve
described, including prevention, right, and in some ways that’s
almost self-evident, right. That if you get in front
of conditions before they become emergencies,
it’s less expensive. It’s better for people’s health,
but it’s also less expensive. By treating folks in a
preventive way rather than folks ending up in the emergency room,
it has a cost saving effect. The fact that insurers,
as you’ve heard Judy describe, have transparency, they have to
explain — they have a limit to how much of your premium dollars
they can spend on administrative costs and profit. That, again, has the
impact of transparency, but it also has the impact of
bringing the cost curve down. So the law was crafted in a
way that was focused both on promoting health but also on
this notion of the fact that costs were moving in
the wrong direction. And just as an economic matter,
the goal is to bring them in the other direction. Kathleen Sebelius:
I think also in the
part of the market that is really broken,
individual and small group market, is really fragile. And a lot of people there are
paying 100% out of their own pocket or trying to pay 100% for
themselves and their employees. The framework is that if you and
your family fall below 400% of poverty, you will qualify
for government assistance, a tax credit to come
into that market. So it recognizes that if you
work often for a large employer, you have a balance. The employer is paying a
portion of your health coverage, and you pay a co-pay,
or you pay co-insurance. But for a lot of people,
they don’t have that. They don’t have that
other stream of income. So when you’re paying
100% out-of-pocket, expensive is expensive. This actually creates a
framework recognizing that a lot of people who were uninsured and
under insured don’t have that other stream of income. They are entrepreneurs. They are farm family. They are out on their own
shopping for their own coverage. So 400% of poverty and below,
you will qualify for a tax credit that can make
the insurance product more affordable. In addition to then having that
tax credit what we know about the market is if you make
companies compete side by side and offer products based
on quality and service, prices come down. Competition is actually
a market strategy. That’s one of the other
issues in the exchange. And thirdly,
we know that on average, people with insurance coverage
right now are paying about a thousand dollars more on their
own insurance coverage for everybody who is uninsured
because folks are coming in through the doors
of emergency rooms, they’re accessing health care,
but they have no payment. So when you have a
stay in a hospital, your hospital cost is actually
higher to compensate for those folks who are in the hospital
who have no coverage. Bringing everybody in to
the market again lowers costs overall. And it’s estimated by the CBO
that premiums will go down across the board based
on competition, based on, as you have heard, the new 80/20
rule which says 80 cents of every insurance dollar
collected has to be spent on health care costs. And starting this year people
will begin getting rebates. Companies that haven’t
met that 80/20 rule, who are spending 25% or 30% on
CEO salaries and advertising costs, we’ve been collecting
that data and starting this year money will be going back
to folks, to customers, to employers, for their health
plans based on not meeting those rules. So there are a whole
series of, I think, things that will
bring costs down. Mayra Alvarez:
Absolutely. So I know we’re all excited,
but we have an online audience as well. (laughter) And I was handed,
I was handed a question from our Twitter audience that asked
what does the law do to protect specifically low-income women? Caya, do you want to
take a shot at that one? Caya Lewis:
Sure. Well, I think the Secretary
outlined what sort of makes this affordable. I think for particularly
low-income women we know that the income limit to be covered
by Medicaid is going to be expanded in 2014. And so now anyone under 133%
of poverty will now be covered by Medicaid. This is important because before
we had categorical coverage in Medicaid and so if you were a
single women with no children and weren’t pregnant,
then you just weren’t eligible for Medicaid. And men, too, without children,
no matter how sick you were or what your income level was. And so we will see coverage for
Medicaid expanded which will allow many low-income women to
get the coverage they need to have their preventive services
be covered and they’ll be able to access care. I think also what’s really
important is that because of the investment in preventive care we
know that oftentimes if you are having tough times economically,
you haven’t been able to get the health care that you’ve needed. And now with the Affordable
Care Act because we’re allowing people to access mammograms,
Pap smears and other preventive services without costs, it will
allow people who haven’t been a part of the system before to
be able to get that baseline preventive care they need to
understand how they can manage their health moving forward. Cecilia Muños:
There is one additional
point I would add to everything Caya said which is
that under both the Affordable Care Act but also the Recovery
Act there is a substantial expansion in community health
centers in this country. An additional 3 million people
are being served at community health centers already as a
result of the changes this Administration has made. And there are more grants online
to continue to raise the number of people who are served and
actually expansion of the physical facilities of
community health centers. So even as we wait for the
Affordable Care Act to fully come online in 2014, there is
already an expansion and access to care, particularly for
low-income folks who are traditionally the folks served
by community health centers. Mayra Alvarez:
that’s a great point. And actually because of
investments of the Affordable Care Act and the Recovery Act,
when you look at our health centers, our hospitals,
they’re often economic engines in some of our most
underserved communities, and communities nationwide. And because of the investments
we’ve made we’ve seen employment at health centers grow
15% because of investments. It’s a tremendous opportunity to
not only provide critical care services but also job
opportunities for people across the country. Okay. Okay. Let’s do the woman
with the pearl necklace. There are many women
with pearl necklaces! (laughter) Linda Kramer Jenning:
Thank you. Good morning. I’m Linda Kramer Jenning
and the Washington editor for Glamor Magazine. And we had a question from one
of our readers about why can’t state governments dictate where
federal health funds — how can they dictate where federal
health funds are allocated? She’s concerned about what some
states are doing on Planned Parenthood, for example. Secretary Sebelius:
So the question is why can they or can’t they? Linda Kramer Jenning:
Why can they put their hands in and change things? Secretary Sebelius:
Well, it is a concern
about women having access to services and women
having a choice about what services they want to access. So our department, and I do want
to recognize Dr. Nancy Lee is here who is head of our Women’s
Health Office — Dr. Lee is right back there — our
department helps to run the Title X program which provides
family planning services for low-income women and has
been in place for years, as well as the Medicaid program
which also provides a range of services. And we are watching very
carefully as states renew contracts and pass laws to make
sure that women in that state have access to a choice of
providers which is required by the Medicaid law,
that women have a legal right to choose providers. And that in the Title X law that
there are adequate numbers of providers throughout
the state based on the population services. So in a number of cases where
there are states that try to cut off services that would have
impacted literally millions of women and their ability to
access health services that they need, we have been
in, I would say, active conversations about the
need to give us the information that ensures those women
have services and have a choice of providers. And in some cases in the request
to alter their Medicaid funding, which is a state/federal
partnership, and again eliminate services,
we have denied those amendments because they in some
instances violated state law. Judy might want to comment on
this because she and her center have been watching this
very, very carefully. Judy Waxman:
Yes, thank you. And thank you, I wasn’t going
to jump in but I’m happy to. (laughter) Basically what some
of the states are trying to do is, I mean, the Secretary
really alluded to it, the two things is to
redirect some federal money, particularly through Medicaid. Medicaid really pays the lion’s
share for family planning services in the states. And that they cannot do
because of the federal law. Because as the Secretary said,
the federal law requires that providers, all providers
be able to participate. And so the state
simply can’t do that. There is litigation going
on in a number of states, but I am confident that
that will be pushed back. What the governor or state
representatives and legislators are also trying to do is cut
their own state funds, and that, of course, is a different story. And that is one that
women in the states have to pay attention to. Mayra Alvarez:
Great. Thank you. Another question? The woman with the red glasses. Stephanie Phillips:
Yes, my name is
Stephanie Phillips, I’m Founder and Editor and
chief of beccastone.com, it’s a website for
mothers of black children. And my question is, it’s been
a long history on documented of minorities receiving —
having disparities in access to health care. And I was wondering what
incentives or programs are in the Affordable Health Care
Act to ensure that minority communities actually receive the
benefit and take advantage of the preventative services that
are now covered by the act? Secretary Sebelius:
Well, it’s a great question. And one that I have to tell you
if things keep me up nights, that’s one is we have
documented health disparities for generations. We haven’t done a very good
job of closing those gaps in health coverage. I’d say the passage of the
Affordable Care Act in and of itself is a huge step forward
because having a health home, having the ability to access
affordable health coverage is a big step forward for lots of
minority families who right now don’t have affordable health
care and we know end up not accessing a doctor’s visit
until something acute happens. Not getting the checkup that you
could prevent — you heard the difference in breast cancer
deaths, for instance, early screening,
early detection, we know, saves incredible lives,
but finding it late is a death sentence. So the difference of having
a mammogram and not having a mammogram can sometimes
be absolutely critical. So passing the act, having
preventive services with no co-pays is again taking down
another financial hurdle that people had. If you have to have a 50 or
sometimes $250 co-pay for a colon cancer screening or a
mammogram or to get your kids vaccinated you may not be able
to do that on a regular basis. So that’s another big step. But we really need your help. I would say that’s a great
question because looking forward to 2014, access is a piece
of the puzzle but it’s only an opportunity. It only matters if people
actually enroll and engage. If they know what’s coming, if
they have some time to think about what’s good for
them and their families. So part of what we’re beginning
to have conversations about, and we would welcome all of
your readers and listeners and bloggers and tweeters
to be well informed, help us with strategies of how
to reach particularly the most vulnerable communities. The people who need
the services the most, who have the least
amount of sophistication, often they are not sitting
online on a computer. They may not be following the
fact that there is now a law that is passed that is going to
have some benefits for them or law in effect right now that
has some benefits for them. So we really welcome at the
department ideas and strategies. We’re trying to partner
with faith-based leaders, with community leaders,
with health care providers, with business leaders, with
certainly women’s groups and media folks to try and begin to
get the message out that the law is changing. And that benefits
are on their way. But thoughts and ideas that you
all might have about things we could do better,
partnerships we could have, we will have community outreach
workers begin to work on this and again tell people that a
change is coming and how people can enroll. And part of what we’re doing is
trying to make sure that when someone is ready in January 2014
to enroll perhaps for the first time in health care,
that it as simple and as seamless as possible,
that the person doesn’t have to figure out what they are
eligible for or qualify for. That they can pick up a phone
or go on a computer or go physically to an office and that
there will be one gateway for that person to come
into the market. If they are
eligible for Medicaid, they and their family will
be enrolled in Medicaid. If they are eligible for
an insurance exchange, they will be given
those choices. But that the experience
should be simple, easy, one-stop shop for folks
to become engaged in the health system. But your ideas and thoughts
about what we need to do, the communities we
need to work on, how to reach out to the most
underserved and vulnerable communities, would
really be welcome. Mayra Alvarez:
Absolutely. I mean, I think that’s one of
the main reasons we’re having this conversation today. I mean, this town hall is
an opportunity to have that discussion with real
people across the country, with leaders in the
Administration to talk about what do women need to hear
about the benefits available to them today. Whether it’s, you know,
via Twitter or Facebook or if it’s an application like text
for babies that’s been very successful with underserved
communities across the country, how can we learn from those
efforts to make sure that by 2014 we’ll be ready. So let’s take it back
to our media panelists. Kelly, let’s go
with you this time. Do you have a question
from your audience? Kelly Wallace:
I do. I do. And this comes
from Sharon Rowley. She is a mom of six. Mom of six. She is very busy. (laughter) And she said with
the economy being so tough and people losing their jobs one of
the toughest things they have to face right after the job loss
we all know is how to deal with maintaining medical insurance. And we know often the only
option available is to take the coverage covered by COBRA. But since the employer is no
longer paying a share of the coverage, the cost for COBRA we
know astronomical and sometimes just not possible for a
family who lost their income. So her question is what other
options are available for people in this situation? Secretary Sebelius:
Well, as she said, and it is a very
tough situation. COBRA coverage when you are
paying a hundred percent of what your employer coverage is not
affordable for lots of families. So a couple of things. The children,
the six children may now, because of the family income
level changing dramatically, may qualify for programs they
didn’t qualify for with a fully-insured family. So that would be one
thing to check out, whether they qualified for
other Medicaid or the Children’s Health Insurance Program which
is based on income levels. But since the family income
level has dropped pretty dramatically, that could
be an option for now. If one of the parents has a
preexisting health condition or a child has a preexisting
health condition there are the preexisting health condition
pools which are also in place so trying to fill gaps
in the marketplace. And the site online
healthcare.gov could give them a snapshot of what’s in the market
at what price and it gives you a range of, you know,
how high a deductible, how to lower premium,
you know, do you want to look for a lower premium. So, that may be an
option for the family. And then know in 2014 there will
be a series of options that may not be available right now. Expanded Medicaid coverage
for the lower income. And for the first time as
Caya a said around the country regardless of where you live,
you will qualify for Medicaid at a standard rate. So that is an option. And then tax credits available
for the next group of income up to 400% of poverty in the new
health insurance exchanges. So there are a whole — there
are some options now and many more on their way. But the family might be able to
find coverage for the kids and different coverage for the
adults that is more affordable than ongoing COBRA coverage. Mayra Alvarez:
Absolutely. I mean, I think that’s one of
the greatest benefits of the Affordable Care Act is this
opportunity to buy health insurance in the private
market in a way that’s easy to understand, transparent, and
you are able to purchase the coverage that’s right for you. So 2014 is just
around the corner. Let’s go in the back. Kim. Kimberly Inez McGuire:
Hi, Kimberly Inez McGuire with National Latino — Mayra Alvarez:
Kimberly, I don’t know if people can hear you. Would you mind walking over
to the microphone, please. Kimberly Inez McGuire:
Hi, Kimberly Inez McGuire with the National Latino Institute
for Reproductive Health. I wanted — so we’ve heard some
about how the ACA will help low-income folks and
communities of color. I was wondering if some of the
panelists might speak to how the ACA will help LGBTQ Americans. Judy Waxman:
Oh, well, you know, there is a great provision that
a lot of people don’t know about and I can tell you it’s section
1557 — (laughter) — because everybody knows what that is. In our office everybody
knows what 1557 is. And it is a nondiscrimination
provision that has not existed in the past and it is built
on other civil rights laws but translates them to, I mean, I
should say brings it over to health care. So LGBT is not mentioned
directly, but sex is. So there cannot be
discrimination on the basis of sex in health care. It’s more complicated than
that but that is basically the way it goes. And I’m happy to
say the department, in writing regulations —
HHS, the Secretary, thank you, and the staff — interpreted
that provision in the exchange regs as saying that did extend
to saying there could be no discrimination on the
basis of sexual identity or sexual orientation. So this is a step into
acknowledging that there is discrimination that lots of us
don’t want to think about but does exist in health care. And it is a way to make sure
over the future that that is eliminated. So we can thank
the ACA for the law. And we can thank the Secretary
for the interpretation. Mayra Alvarez:
I will not pretend
to be a lawyer because I am not, but I do want to say
that Section 1557 is in effect and is already being enforced
by our Office of Civil Rights. And just to build
on what Judy said, sex discrimination in case
law has generally covered gender identity. And as a result of that it’s
going to speak volumes to the LGBTQ community
across the country. Another question from
the audience, please. Secretary Sebelius:
Can I add just one thing — Mayra Alvarez:
Oh, I’m sorry. Secretary Sebelius:
— to the LGBT issue. We are also, for
the first time ever, going to add questions on LGBT
health issues to the National Health Survey. It’s never been done before,
so a lot of what’s been done in health care for LGBT persons
has been based on anecdote, not on data. And that will be a
huge step forward. Mayra Alvarez:
Absolutely. Can I have someone
with a green badge? Sorry. No one has a green badge
that has a question? (laughter) Here you
go, Keith, over here. I am just trying to be
mindful of our audience. Amna Abas:
Hi, I’m Amna Abas on
behalf of the Asian and Pacific Islander
American Health Forum. I think some of the panelists
have spoken today about some of the challenges that women
of color and low-income women experience. One of the issues is that
there is not a lot of data for communities like
Asian Americans, native Hawaiians and Pacific
Islanders on, you know, what exactly is happening
on their health and how can providers and researchers
work together on good policy solutions. So can you tell me a little bit
more about how the Affordable Care Act is going to help our
researchers and providers better serve these communities? Mayra Alvarez:
Absolutely, and I
think it’s going to build on what the Secretary talked
about the LGBT data collection. Caya, do you want to take that? Caya Lewis:
That would be Section
4302 — (laughter) — for the wonks in the room,
but the Secretary just mentioned that the Affordable Care Act
actually directs the department, and we have already done so,
to collect race, ethnicity data, primary language data throughout
our surveys and our programs. So that’s already started. The Secretary mentioned we’ll be
adding LGBT sexual orientation questions to our surveys. And it’s such a good question
because we can’t tell where we’re going or how we’re doing
if we don’t have data on all of our populations. And there are populations, many
in the Asian Pacific Islander communities that are smaller
populations and we don’t even really even see what
the disparities are until we start breaking out
ethnicities amongst them. So that is going to be something
that really advances what we do at the department and allows
us to see how we’re doing, how we can improve, and how we
can begin to close those gaps. Mayra Alvarez:
Yeah, and specifically
within the Asian Pacific Islander community,
and there is such diversity between different
segments of that community. To have that granularity in
our data collection efforts, is going to be able to better
give us the understanding of what the needs are so we can
meet them better in the future. Okay. The woman in the black
jacket with the blouse. Thanks for letting me describe
you as I call you out. (laughter) Susan Campbell:
Hi, I’m Susan
Campbell with WomanHeart, the National Coalition for
Women with Heart Disease. And one of the things that I’m
interested in hearing more about with the women’s health issue
is that when women get access to care, which we’re
all talking about, that’s very important
for prevention. But with heart disease and other
diseases it’s a life-long issue. So access to care will help
quite a bit with secondary prevention so that if you have a
health issue with good access to care, better information,
you can maintain your health. And I just thought you might
want to speak to that because I think that’s really important
for women’s health as well as for the health care system
in terms of saving dollars, et cetera. Secretary Sebelius:
Well, WomenHeart
is a great partner and a great leader in reminding
women that heart disease is something we all a need to be
conscious of and deal with. And I’ve been delighted to have
a chance to work with Susan. Part of what again
is not well known, a lot of people understand that
the insurance pieces of the Affordable Care Act, what is
not as well known are the major effort in the Affordable Care
Act to really improve patient care whether you have
insurance or not, frankly, care is kind of
mixed and spotty. Some care is very, very good
and providers do absolutely the right thing for the right
patient each and every time. And then other places that
doesn’t happen so much. And so one of the efforts is
to identify some areas where we know there is some best
practices and try to make them national best practices. Have everyone and an effort
underway under the umbrella of the innovation center,
the first of its kind, kind of research and
development center that Medicare and Medicaid has had. Money is actually being put into
helping identify best practices, inform providers about them,
make them national models, begin to pay on strategies that
we know produce good outcomes. And one is the Million Hearts
Campaign which WomenHeart is very much a partner in. And it really is about the fact
that we know we could prevent a million heart
attacks and strokes, a million heart attacks and
strokes in the next five years by doing some relatively
simple protocol. And it’s really the ABCs. Aspirin protocol for people
where it’s recommended who have heart indications;
blood pressure control; cholesterol control;
and smoking cessation. Those are the underlying
elements that if a patient is at risk for heart disease or has
had a heart attack that we know can be a management tool. And unfortunately even
with people with insurance, there are lots of folks out
there who are not managing their conditions, who know that they
have high blood pressure and are not taking steps to lower
that blood pressure. Who do not take the aspirin
regimen to keep their heart on a more normal course. Who are not managing
their cholesterol. And so they are at a very high
risk for another incident. And part of that effort
around a Million Hearts, but there are lots of those
protocols underway to try and really improve care
for all patients. And, frankly, it
also lowers costs. You know, you hear a lot of
that discussion about, well, you can’t possibly lower
cost and improve care. You have got to do
one or the other. Absolutely not true. If indeed we prevent a
million heart attacks, that’s a lot of hospital days. It’s a lot of follow-up care. It’s a lot of very high
health costs which actually won’t happen. So keeping your blood pressure
under control is a whole lot, not only better for the patient,
but a whole lot cheaper than a second heart attack and
those hospital days and those follow-up costs. So really you can improve
care and lower costs. And that’s part of the direction
of the Affordable Care Act using strategies that we know work and
we know are in place in pockets in areas but are not being
followed by every provider every time for every patient and
trying to put together systems that make that happen. Mayra Alvarez:
Yeah, that’s a great point. It really underscores the fact
that the Affordable Care Act isn’t only going to help the
over 30 million people that will get health insurance come 2014,
but it’s going to help the millions of us that have health
insurance today so that when we go see our provider,
we’re going to have more time to spend with them. We’re going to be able to
have our questions answered. We’re going to have a quality
care experience that we are all expecting when we go to
our hospital or clinic. So that’s a great point. And thank you for that question. Okay. Woman in the black jacket. Uh-huh. There are many of those. Secretary Sebelius:
That’s a dangerous identifier. That’s about half — Mayra Alvarez:
She was giving me the eye. That’s me. Jerry Pemberton:
My name is Jerry Pemberton, I’m with the Black Women’s
Health Alliance at Philadelphia. I’m also an RN and I’m also a
patient seeing many disciplines in health care providers. And I have a concern and
question about whether the act will cover collaboration between
different health providers as far as the documentation and
some uniform process that they can use which would cut down on
duplication of tests, et cetera. Mayra Alvarez:
Absolutely. I can start it. So one of the many provisions of
the Affordable Care Act is the concept of community health
teams to do just that. To make sure that providers from
nurses, to physician assistants, to doctors are really working
collaboratively to give the patient the full
continuum of care. The Secretary alluded to this,
but the new innovation center at the Centers for Medicare and
Medicare Services just recently launched the support of 26
innovation awards across the country where generally the
federal government funds these demonstration projects based on
our great ideas for what works for health care. These awards flip that and
decided the communities, the states, bring us your ideas. What is improving quality? What is saving costs? And apply for these funds and
we’ll take a look at what you’re promising to do and we’ll
support those initiatives. And we launched that
first set, the 26 awards, just a couple of weeks ago. So you are looking at models of
care to incorporate community health workers or to focus on
prevention in Indian country. To try and figure out how these
new models of care can save dollars to the system and
improve quality of care. A number of those awards looked
at ways in which providers can have those partnerships. Secretary Sebelius:
Well, I would say in addition to what Mayra said about
these innovation grants, what we know is a couple
of things and it’s been demonstrated over again that
the health systems where the providers work in
collaborative teams have by far the best results. And so that’s a model which is
not only effective in reducing everything from hospital-based
infections when everybody is empowered to be a part
of that safety culture, to lowering costs and
delivering more efficient care. So we are funding
lots of those models. Medical home model. When a patient is either at risk
of going to the hospital or has been released from the hospital,
which really involves a team of workers that actually try to
help keep those patients healthy in the community. Teams in hospitals. And everything from team
training to team collaboration around hospital-based
issues are also part of the funding package. So there are lots of strategies
that really recognize that by far the best care is
delivered when providers talk to one another. And I would say huge
platform for this, pre Affordable Care Act,
but it’s very exciting work that’s underway,
is the conversion of all systems of care to
electronic medical records. And that does three
things really quickly. First of all, it gets rid
of a lot of paperwork. It enables primary care
providers and others to coordinate care. They know what
tests have been done. They don’t have
to duplicate tests. They can see care strategies. And it gives information to
patients for the first time that they own, they control,
they can monitor. So we started three years ago
when this President came into office, less than 20% of doctors
and only about 10% of hospitals in this country use any kind of
comprehensive electronic record. I mean, think of that. So you can’t measure care. You can’t figure
out what’s going on. You can’t share care strategies. People were exchanging paper. I don’t know how many of you
got the famous clipboard. You go into a provider’s office
and it’s like you fell off the face of the moon; right? You start all over
again with who you are, where you came from. So we are now at the
point where we have about, we doubled that number, we have
about 40% of hospitals and we’re on track to have probably half
of the primary care providers by the end of this year involved
with a comprehensive record. And the trajectory
is on its way up. So we will have a system of
communication, measurement, identification and information,
patient empowerment for the first time ever in this country
that I think also gets to some of the strategies that we
know are very effective, but it’s harder to do that if
you’re changing paper files, if the nurse doesn’t know what
the doctor really ordered, if nobody can follow the
prescription and see if it’s been filled or if it’s
the right prescription, you don’t know what
test has been given, that system is changing. Mayra Alvarez:
Absolutely. Okay. The woman in the blue
with the no sleeves. Sara Austin:
Hi, I’m Sara Austin, I’m a features director
at Self Magazine. I wanted to ask about the kind
of black cloud hanging over the Affordable Care Act which is
that the Supreme Court could overturn it as
soon as next week. I’m wondering if the
Administration has a plan of attack for if that
unfortunate circumstance should come to pass? Secretary Sebelius:
Well, I would say
we still remain confident and optimistic that
this change in the law was well within the purview of Congress. It fits into about 70 years of
expansion of the commerce clause and clearly as we
have discussed today, people who are outside the
health market impact the health market each and every day. By either not having or
not purchasing insurance, you influence the price
of the marketplace. Having said that, you know,
we’ll be ready for court contingencies. What we’re doing
right now, frankly, is just working as hard as
we possibly can to get ready for 2014. Because the, you know, the range
of options that the court was asked to deal with are broad. We think that it’s the best
preparation to, you know, anticipate that the law is fully
constitutional and that people are eager to be eligible
for these new marketplaces. And frankly some of the
deadlines are pretty daunting. To set up new markets in
states around the country, to work on the kind of expansion
programs that we’re talking about, to do the outreach
and communications. So we’re well underway doing
just that and we’ll continue to implement and then,
you know, be ready. Mayra Alvarez:
Absolutely. Okay. This woman with the glasses. Yes. Melissa Ford:
I’m sorry, hi,
Melissa Ford from BlogHer. I’m sorry. I’m Melissa Ford from BlogHer. A follow-up question to that is
what can be undone at this point and what couldn’t be
undone based on the Supreme Court’s decision? Secretary Sebelius:
Well, the plaintiffs
actually in a couple of the cases have asked that
the entire law be struck down. That it be found
unconstitutional. And one of the appellate
court judges agreed with that. The other I think
four or five did not. But one has. So much of what we’ve described
here today would cease to exist. Young adults on their parents’
plan would no longer be the law. Insurance companies could go
back to recision policies, could continue to charge women
significantly more than men. There would not be assistance or
a new market without preexisting health conditions. That would not be the law
any place in the country. We’ve had two years of
incredible changes and improvements to Medicare,
stabilizing preventative services, we assumed that would
be unraveled because those would no longer be the law. We’d have to establish new
Medicare rates because there are some increased rates for doctors
providing primary care and prevention care that are part
of the Affordable Care Act. The money that is currently
available to states to begin to set up this new
market would stop. So this would have 60,000 people
who are now on preexisting health insurance plans who
could not get insurance coverage anywhere else,
those resources that support those plans would stop. So it has some pretty
cataclysmic impact along the way because, really, we’ve had two
years of implementation and millions of Americans have
preventive service benefits, have, you know, contraception
as part of their health plan. Have the ability to get
immunizations for their kids with no co-pays. And we assume if the court would
strike that down those all would cease to be the law of the land. Mayra Alvarez:
It’s hard to believe that an hour and a half has passed by. So we have had a
number of questions, but I’ve neglected
our Twitter audience. So I’m going to go back to that
real quick, if you don’t mind, for our last questions which is
a little more specific as to the preventive services available
specifically for women. In August of 2011 the department
released important guidelines to cover key preventive services
for women’s unique health care needs across their life-span. For the women on the panel,
can you share what specific preventive services that means
for women across the country? Some examples? Judy Waxman:
I have my list right here. Secretary Sebelius:
Bless you! Mayra Alvarez:
I knew somebody would. Judy Waxman:
So, wait. Here, I’ve got it. And there are eight,
pardon me, eight of them. So all of these services
starting August 1st for new plans when they begin,
so again, by January, as I heard the Secretary say
recently the majority of plans would be affected by this and
over time all plans will be. Here are the eight
services: Well-woman visits; screening for
gestational diabetes; HPV DNA testing if
you’re 30 or over; sexually transmitted
infection counseling; HIV screening and counseling;
FDA approved contraceptive methods, the full range of
contraceptive methods and counseling;
breastfeeding support, supplies and counseling;
and domestic violence screening and counseling. That is quite an
incredible list. Mayra Alvarez:
Thank you, Judy. Absolutely. And I do think, you know, the
opportunity to have a well-woman visit, to have an opportunity
to sit down with your doctor and either access these services
or have that conversation about what services are right for you,
a conversation that should be between a women and her
health care provider is a key opportunity that the Affordable
Care Act is going to make a reality. So it’s an exciting conversation
that we’re starting today. So at this time, I want to wrap
up our panel but really bring it back again to the real people
across the country that this law is impacting day to day. Again, I want to introduce one
final “my care” video for you and this one specifically
features Abby Shanfield from Minnesota. So if you could share
the video, please. Abby Shanfield:
Without the Affordable
Care Act my life would be very uncertain
and very scary. ¶ My name is Abby. I’m 20 years old and I’m a
student at the University of Minnesota. I was born with a
rare congenital disease called toxoplasmosis. It is a parasitic disease. And one of the many side effects
is extra cerebral spinal fluid on your brain. At ten months old I had the same
size head that I do now at which point they implant a shunt
that drains the fluid from your brain. And since then I have had four
shunt replacement surgeries. When I was 17, I started to lose
my vision in my left eye and I almost lost all of my sight
completely in my left eye. Usually vision is the first sign
that something is going wrong. I need to have preventative care
in order to take care of myself otherwise the ramifications
could be terrible. And there is no
cure at this point. It’s going to be
the rest of my life. Two eye surgeries. yeah, two. My whole life I’ve been covered
by health insurance thanks to my parents and my family
helping to pitch in and pay for those premiums. So I have been lucky,
and I have always had excellent health care. However, there was a point
before the Affordable Care Act was passed I was very concerned
about my future and whether I would be able to access care. I found out about the provision
in the Affordable Care Act that I can stay on my parents’ plan
until I was 26 immediately. That was one of the most
important things in the law. And one of the most powerful
things for me in my life. Kathryn F. (Abby’s mom):
There are things I can’t
do about the future, but this has really
helped her future. Abby Shanfield:
Given that the
Affordable Care Act has passed into law, I have
a world available to me. You can’t guess what
life will toss at you. Even if you don’t have a
health issue now like I do, that’s uncertain and everybody
deserves a chance at happiness and a healthy life. The health care law is
about people like me. It’s Abbycare. ♪♪ Mayra Alvarez:
And we are lucky to have with us here today Abby. (applause) I know we are running
short on time but I think we want to invite, you know, our
special guests to say a couple of words, please. Abby Shanfield:
Sure, okay. Hi, everyone. I just wanted to thank you
for all being here and for having me. And thank you, Robin, for
your inspiring courage. And to the Obama Administration
for fighting for the health of all Americans. My name is Abby
Shanfield, as you saw, and I was born with a rare
disease called toxoplasmosis. Thus far I have been
incredibly lucky yet my future is uncertain. What side effects of my disease
will emerge throughout my life is impossible to tell. But I do know that I will be
dealing with the physical and monetary implications of
my condition for the rest of my life. Since I was very little,
I have understood that I am limited in what I can do,
where I can travel, and the possibilities
available to me. That is why the Affordable Care
Act is so much more than a law. It is a safeguard against the
unknown as well as a protection from insurance companies using
the terms preexisting condition or lifetime limit to dictate
the type of job I can get, where I live, whether I can
access the proper antibiotics to protect me should I
choose to have children. And most importantly,
it protects me from insurance companies and businessmen
putting a price tag on my life. The ACA is a monumental step
toward an America that is inclusive and doesn’t leave some
to falter while others thrive. Without the ACA I could still
be told that my life is not of value. That it is worth only a finite
amount of money and I am too great of a burden on society
to have access to a full and healthy life. The Affordable Care Act is a
reflection of America’s values of justice and equality. And assures more Americans’
futures will be defined by our collective hopes and dreams
rather than our fears of the unknown. Thank you. (applause) Robin:
Hi, everyone, I’m Robin
and this is my son Jax. As you saw earlier in our video
Jax was born with a congenital heart defect that was part
of a genetic disorder called Trisomy 22. He was in the NICU
for three weeks. He had open heart surgery
at three months old. He was in the cardiac unit
for ten days after that. He has had 30 doctor visits. He is going to have
another surgery at the end of this month. We are so relieved in our family
about this law because we don’t have to take a list and do the
math to decide which doctors appointments are important. His heart obviously
that’s important. Maybe his eyes we can decide not
to take him to do that because that possibly won’t kill him. We are so relieved that that
is not a decision that we have to make. We’re also so relieved that when
this boy, 26 years from now, when I’m really old —
(laughter) — that we don’t have to worry about the preexisting
conditions he was born with when he is finding health
insurance on his own. We’re so thankful to Dr. —
or Kathleen Sebelius, sorry, and we’re so thankful for this
law and President Obama for making sure that our
family is protected. (applause) Speaker Senior:
Hello, I’m going to be very,
very brief. As you saw on the
video I am the senior. (laughter) I am the active
senior who has been involved with senior care as well
as child care for more than 40 years. So my appreciation to the
Affordable Care Act is that I can continue to be as active
as I have been because I know I will have these services
that will be provided for us. So we wish that you would fight
on and on and we will assist with you the fight. Thank you. (applause) Mayra Alvarez:
Thank you, again, each of you for
being here with us. It’s our honor to have you here. So at this time I want to give
a special thank you to our panelists for joining us today. Our invited guests
for being with us. As well as those of you
here in the room with us. And the many of you that are
viewing online for being part of today’s town hall conversation. We’re going to continue this
conversation in the weeks and months and years to come as we
continue to implement the law, as we continue to make sure
women and families across the country know about the important
benefits available to them. Keep up with our updates
via Twitter at our handle @healthcaregov or in
Spanish @HHSLatino. And also on our Facebook page. Just a couple of closing
housekeeping things. For the media in the room if
you are interested in interviews please take a look
at the birthday boy. He’s in the back. He is the one that was
walking around with the mic. He can help coordinate
those interviews. And for those of you that
are staying for the important breakout sessions to go a little
bit deeper into these issues and to learn more about what we’re
doing to improve women’s health, if you could look at the color
code, there is a screen here, explains to you which
room corresponds with your color code. If you don’t have a
color code, don’t worry, pick a breakout room
and we welcome you. So again, thank you
for being part of this important conversation. We look forward to continuing to
work with you and talk with you about what we can do at the
Department and across this Administration to
improve women’s health. Thank you. (applause)

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