Washington, D.C. – Earlier today, U.S. Representative Allyson Schwartz delivered the following opening keynote speech at Citigroup's 3rd Annual Health Policy Conference held in New York City. Schwartz’s remarks focused on her perspective on the short and long-term outlooks for federal healthcare policy.

Schwartz’s remarks were followed by senior healthy policy advisors to the leading Democratic and Republican presidential candidates and select national health care experts. 

Congresswoman Schwartz’s remarks as prepared for delivery follow below.

“I am pleased to be here with you this morning, and I want applaud Citigroup for their decision to focus this year’s health policy conference on the problems of the uninsured and barriers to affordable health care.

“As a member of Congress, there is no other issue I hear more about, and there is no issue I believe more fundamental to our families, our businesses and our economic future.

“This conversation is certainly not a new one. We have been discussing for decades how do we contain the rising costs of health care and expand coverage, and we have not come to consensus on just how to do this.

“But, given the new Democratic Majority in Congress, and anticipating a Democratic president there clearly is a shift in how we approach the issue of how to ensure all Americans have access to affordable and quality health coverage. 

“As our country moves forward with new leadership and new priorities, it is imperative that you as stakeholders understand where it is a Democratic controlled government will be leading the nation, which is what you have asked me to do this morning.

“It is a certainty that when the new President gives her first state of the union address health care will be a major part of the agenda.

“Why?  Because we believe that the status quo is not acceptable.
 
“Small businesses cannot afford to insure new employees, often delaying new hires.

“Large corporations are finding it hard to manage the costs of their current employees’ benefits, let alone their retirees. 

“And, American families face serious dilemmas - many rightly live in fear that they too will lose their health insurance or that their coverage will be dramatically inadequate when they do need care.

“Look at the facts.

“Health insurance premiums have risen at twice the rate of inflation – a 75% increase in the last six years.

“While more than half of all adults get coverage through their employers, 47 million Americans are without coverage and millions more are underinsured.

“The financial ramifications on the uninsured and underinsured are immense - medical debts and expenses are the number one cause of personal bankruptcy.

“The federal government already pays 46% of our nation’s health care costs, $600 billion annually on Medicare and Medicaid alone. 44.6 million Americans rely on Medicare. 44% of nursing home care costs are paid by Medicaid.

“And the government recently took on a new spending mandate for prescription medication under Medicare Part D, which is unaffordable without negotiations of drug pricing. 22% of drug spending is now paid by Medicare, up from just 2% in 2005.

“These are the harsh realities of health care in our country.

“We must do better, and the new Congress is committed to changing the status quo.

“We in the Majority are pretty clear.

“It is critical to provide health coverage for all Americans and contain the costs of health care both in public programs and in the private sector.

“These issues should not be ignored.

“No one in this room believes that government will be absent from the solution. We have too much at stake. We are too clearly a major player.

“Nor should we underestimate the significant role the private sector has as payer, provider, consumer, and as innovator.

“What I hope to provide today is a look at our immediate priorities, and the change that is surely coming.

“I have been involved in health care for many years – as a health care executive; as an advocate; as the wife and mother of doctors; and for more then 15 years, as a state and federal policymaker.

“From these experiences, I have a deep understanding that no one is immune from the difficulties in navigating our health care system.

“I am also keenly aware of the economic assets of our health care ‘system,’ in my district, and across the nation: in research and development, as suppliers and producers; in medical education; as a provider of care. We are, and should continue to be, on the cutting edge of medical advancement and medical services.

“It is my firm belief that the economic competitiveness of this global marketplace requires us, as Americans, to face the challenges of the demand for and costs of health care.

“That the high cost, unpredictability, and uneven distribution of risk is a factor inhibiting our business’ capacity for growth and success. The costs of health care are jeopardizing the very innovation and competitiveness that is the strength of our nation.

“And, I believe that the responsibility we have taken on in government to provide for the health care of our elderly, our poor, and our disabled requires us to be more cost effective and efficient, as well as to better focus on prevention and improved outcomes, rather than solely just paying the bills.

“So where are we?

“Why have we not controlled costs or found the answer for the uninsured?

“Consider for a moment the Children’s Health insurance Program (CHIP). 

“As one of the original architects of CHIP in Pennsylvania in 1992, I remember well the debates that led to what five years later became the model for the federal initiative.

“We knew then, as we do now, that increasing numbers of children of working parents did not have health coverage.

“My colleagues, led by Democrats, but supported by both Democrats and Republicans, believed expanding affordable market coverage was not only a moral imperative, but a smart investment.

“And we found the answer in a public-private partnership. Despite enormous obstacles with addressing a new insurance product, we successfully created one of the first CHIP programs in the nation, bridging the divide between the public and private payers and enabling lower-middle income families access to private coverage.

“Now a federal initiative, 6.6 million American children have health insurance coverage under CHIP.

“But for a Presidential veto… well, in fact two Presidential vetoes, 4 million uninsured children would have been added, and we would have been close to universal coverage for all American children.

“In fact, what I think drove the veto was not that it was too costly, it was paid for, or the increase in cigarette taxes. It was that the Administration was scared that if we could find a way to ensure universal coverage of children, than maybe we would also find market based solutions for insuring all Americans.

“Whatever the rational, we have yet to reach agreement with the White House or the majority of Republicans in the House on continuation and expansion of CHIP – the most successful and popular health coverage initiative in the last two decades.

“Beyond the debate on CHIP, which we will resolve on some level in the next few weeks, we are moving forward on a number of reforms to expand access to health coverage, to control costs,  make health care more affordable for businesses, and provide incentives for innovation in health information technology.

“There are a few things you should be aware of as we conclude this half of the 110th Congress:

“Under Medicare we expect to:

“Shift reimbursement to encourage prevention and chronic disease management.

“To rein in unnecessary overpayments.

“Make an initial investment in comparative effectiveness.

“Allow for price transparency of medical devices.

“Incentivize e-prescribing.

“And reverse the cuts for Physician’s Services.

“Going forward, 2008 will lay the groundwork for substantive change in 2009 and beyond.

“The face of that change is complex, but required.

“Here is what I believe we will do.

“Health coverage must be available in the workplace quickly and it must be portable.

“There needs to be greater access to affordable insurance between jobs, and because of this marketplace rules for insurance coverage related to pre-existing condition exclusions, waiting periods, and portability have to change

“And given the many companies with facilities in numerous states, I will work to change this at the federal level, rather than state-by-state.

“Small business is where much of the new economic growth is, and yet current regulations make it difficult for them to cover their workers. Health insurance is by far the most expensive for smaller groups. Again, new rules on risk sharing, like community rating, reinsurance or access to larger groups is a must. Deductibility of insurance must be equitable for individuals and employers.

“And, we have to insist on coverage for prevention and chronic disease management, even if the financial benefits take years to accrue and may be applied to a different employer or a different insurer. Disease prevention and long term costs of neglect results in greater costs for us all.

“The demographic with the largest percentage uninsured is 55-64 years old. Serious consideration will be given to enabling those early retirees without health insurance to buy-in to Medicare – Adding younger, healthier people to the risk pool (but also extending Medicare’s reach and responsibility.)

“Government, as the largest single payer of health coverage, will be smarter in how we finance government programs. The incentives and infrastructure for the future need to be built now.

“We should start with a commitment to use the enormous amount of data available to learn more about what works and what doesn’t and communicate best practices and insist on quality performance.

“Whether comparative effectiveness analysis leads to cost savings and improved outcomes is not yet know for sure, but we should begin to move towards more evidence based practice and financing.

“Government and private insurers have to pay fairly and adequately for needed services. The Democratic Majority in Congress recognizes that there are cost inefficiencies in particular in relation to private for profit industries. These resources must be redirected to maximize taxpayer dollars.

“Given the 21st century technological environment, we must incorporate new tools into the health care system, including incentivizing electronic medical records, starting with requiring “e-prescribing” which is already known to reduce errors and save lives.

“We will invest in research and innovation, and put our federal dollars to work on the cures and treatments of tomorrow. Medical devices, pharmaceuticals, new biopharmaceuticals, and vaccines can be found – if we are making the investment in basic research and stimulating research and development in the private sector.

“Funding for the National Institutes of Health, access to venture capital for biotechnology, and incentives for training of scientists, doctors, nurses and other medical personal is essential. America has always been a leader in scientific discovery. Now is not the time to leave this to other nations.

“And lastly personal responsibility is a requirement. This means American living healthier life styles, and it also means a public and private commitment to food and product safety, to clean water and clean air, to environmental and occupational safety, to promotion of sound nutrition and exercise, and to smoking cessation.

“And these are just the short-term goals!

“Reducing costs for government and businesses, expanding coverage through marketplace reforms, sharing risk, encouraging good health practices, creating more predictability – all are important, both in the short term, and in achieving the long term goal of accessible, affordable health care for all Americans.

“And, they are all achievable.

“We as Democrats accept that it is our responsibility to tackle this challenge and create a uniquely American solution.

“I welcome the challenge, and I call on you all, as leaders, as innovators, as investors, to help us further strengthen the partnership between the public and private sector to help build the health care solutions of the future.

“The decisions you make should count on government getting smarter, more efficient, and more forward thinking, because the Democratic Congress and the next Democratic president are determined to make universal coverage and cost effective, affordable health care more than just a debate. We expect to make it a reality for all Americans.

“Thank you.”

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