‘We All Benefit from Medicaid,’ Remarks by HHS Secretary Sylvia M. Burwell, Nov. 4, 2014

Remarks by Secretary Sylvia M. Burwell United States Department of Health and Human Services at the National Association of Medicaid Directors Fall Conference

Washington, D.C. –(ENEWSPF)–November 4, 2014.



Thank you, President Gordon.  I’ve very much been looking forward to meeting with you all today. 

Let me begin by saying thank you.  The odds are that in all our states – whether it’s my home in Hinton, West Virginia, or here in Virginia – there is a child who is at a check-up right now, thanks to CHIP coverage. 

As we speak, Medicaid beneficiaries – children and adults – in all our states are filling their prescriptions, getting lifesaving treatments, and working with their doctors to take control over their own health.  All this is possible because of your hard work and the hard work of your teams. 

There are a number of tools we have to protect the health and financial security of millions of Americans – whether it’s Medicaid, the Marketplace, or employer-based coverage. And today, we have the opportunity to work together to extend this security to millions more. 

Having coverage can mean that you no longer must choose between paying rent and taking your child in for a checkup.  It can mean that you no longer have to choose between keeping the lights on or filling a prescription.  It can mean your entire monthly grocery budget won’t be swallowed up if you have to see the doctor.  If you are in a period of transition in your life, you can have coverage.

Of course, whether or not we happen to be beneficiaries ourselves, we all benefit from Medicaid.  Our economy benefits from a population that’s healthier, a workforce that’s more productive, and working families who have disposable income. 

Because Medicaid spurs progress in all 50 states, we want to bring Medicaid expansion to all 50 states – and we are eager to work with any and all states in partnership to make this happen.

And because we all benefit when Medicaid works – both the people it serves and the taxpayer –  we’re also committed to working with states to make it work better.

This is what I’d like to talk with you all about today.

Affordability, Access, and Quality

I think it’s worth starting with some context.                                        

Since President Obama signed the Affordable Care Act in 2010, we’ve made tangible progress as a country on affordability, access and quality. 

When you consider the law through this lens: The Affordable Care Act is working – and families, businesses and taxpayers are better off as a result.  Four years after President Obama signed the law, middle-class families have more security, and many of those who already had insurance now have better coverage. Fewer Americans are uninsured. At the same time, we’re spending our health care dollars more wisely, and we’re starting to receive higher quality care

On affordability, 70 percent of Americans with Marketplace insurance plans feel they can now afford care if they get sick, and a majority say their premiums are easy to afford – according to research from the Commonwealth Fund. 

We’re also making tangible progress on quality.  As an example, as a country we saw 150,000 fewer unnecessary hospital readmissions from 2012 to 2013.

On access, 10.3 million fewer adults are uninsured today than in 2013.

So this is an important piece of our work to make sure that Americans have access to quality, affordable care.

Let me take a moment to tell you about one of these Americans …

Medicaid Expansion

If you hop on the Capitol Beltway on your way home, and take it to Route 50, you’ll get to Anne Arundel County, Maryland.  There’s a 59-year-old man who lives there by the name of Purnell Taylor, and I want to share his story with you.  Purnell drives for a taxi and limousine service.

Five years after losing his wife, he lives alone.  He doesn’t have employer-based health coverage.  With a pre-existing condition and a limited disposable income, it’s been hard for him to find quality coverage on the individual market that he can afford.

Purnell went for years without coverage.  Then Governor Martin O’Malley signed legislation to expand Medicaid – becoming one of the first states in America to do so.  Today, Purnell is covered.  He’s able to see a doctor regularly and to get his prescriptions at a local pharmacy.

In states across the country that are moving forward with Medicaid expansion, Americans like Purnell are benefitting.

Let the record show that since last year’s Open Enrollment period an additional 8.7 million Americans now have coverage through Medicaid and CHIP – many for the very first time.  And 7.5 million of these people live in states that have expanded Medicaid.

That’s why expanding Medicaid is one of my top priorities as Secretary.  And I hope it will become a top priority for those of you who haven’t yet expanded.

Now I know today is Election Day.   I’m not a politician, and I’m not here to comment on politics. What I do want to do is use our time together today as an opportunity to focus on the things we can do together.

Today, we see that governors and legislatures from both parties are moving forward with expansion – including most recently Pennsylvania.  Pennsylvania expanded in its own way, and this will now open the doors of opportunity to hundreds of thousands of Pennsylvanians.

States like Arkansas, Michigan and Iowa have also expanded in their own way – and it’s making a difference for their states.  And that’s because this isn’t about politics, it’s about people.

Quality health coverage allows children to perform better in school.  It allows adults to reach their highest potential on the job. 

It’s a fair deal for hardworking Americans.

It’s also a good deal for states.

The federal government covers 100 percent of the cost through 2016 and never less than 90 percent after that. 

This funding isn’t going away, and just as your state can choose to expand at any time, you also reserve the right to change your mind.  Not only that, Medicaid spending per enrollee continues to grow at a slower than anticipated rate – we’re getting more bang for the buck.

If all states were to expand, millions of our fellow Americans could get covered – including many who currently fall into a “coverage gap.”

What’s more, there is also real evidence to suggest it can have a positive impact on costs and economies. 

A recent Kaiser report found, for example, that state Medicaid costs are growing at a notably lower rate in expansion states compared to non-expansion states. Another report from the President’s Council of Economic Advisers found that states that had expanded Medicaid in 2014 would add more than 350,000 jobs by 2017, and states that hadn’t expanded are leaving nearly 380,000 jobs on the table.

We Want to Work with You

Before moving on, I want to reiterate that we’re eager and willing to work with states that have yet to expand.

One of my first meetings as Secretary was with a group of governors from both parties.  I told them I hope to work with them – all of them – to bring more states into the fold on Medicaid expansion.  I also told them I understand that every state has different needs.

We understand that there are many complex issues around expansion. That’s why I am personally engaged with Governors – across the aisle and across the country. And Cindy Mann and her team at the Center for Medicaid and CHIP Services are working all day, every day to do the same.

We worked with Pennsylvania and we want to work with other states, who are also interested in expanding – to help meet the needs of their residents.  

The law allows for flexibility so individuals with disabilities can continue to live in their communities, beneficiaries can access integrated care, and states can test new payment and delivery system reform models that can improve care while spending dollars more wisely. 

So my message to governors is that “if you’re interested in expanding, call me.”  And to those governors who are about to get elected or re-elected today my message is that “I’m happy to meet with you before your inauguration.” We welcome conversations as we work together to move forward.

We’ve already worked with 27 states and D.C. to make this happen, and we want to work with you.   

Improving Quality; Spending Dollars Wisely

Another area where we’re seeking partnership from across the spectrum – and actually across sectors – is in improving the way we provide health care for Americans throughout the country. 

At HHS, our vision and our belief is that Americans will have better health outcomes and we will spend our dollars more wisely if we find better ways to deliver care, pay providers, and distribute information.

To drive progress, we’re focused on better care coordination and integration. We’re focused on engaging patients more deeply in decision making.  We’re also focused on improving the health of our communities – with a priority on prevention and wellness. 

I know you share these goals as well, because many states have been leading the way – particularly those working in the Medicaid space. 

At the federal level, we’re working with many of you to find better ways to pay providers through payments for care coordination, shared savings, and payments for episodes of care.

We are also working with you to further improve the delivery of care to beneficiaries enrolled in managed care.

And we hope to partner with all of you on efforts to make information more widely and readily available for use both by providers and consumers.

One of our priorities is to make markets more transparent.  One of the ways we are doing this is by posting quality information on hospitals, physicians, nursing homes and other providers online – and this makes it possible for consumers to learn about clinical quality, safety, care coordination, and patient experience.  Transparency helps drives improvement.

Another is to advance the adoption and use of Electronic Health Records – now, we have a little experience with the challenges of technology! 

As a nation, we’ve made some dramatic progress in adopting Electronic Health Records – thanks to initiatives like Meaningful Use.  This has allowed us to reach a tipping point in digitizing the care experience. 

To continue moving forward, our goal is for electronic health information to be available, shared and put to appropriate and good use.  Doing so helps make quality measurement and value-based payment seamless. More importantly, it allows us to save lives and improve public health.                                

Therefore, we are working on a clear and achievable interoperability roadmap that will bring value to the data for you, your providers, and for consumers. 

There are also a number of areas in which we’ll be looking to you to show us the way.  One of these areas is medical homes.  We are interested in the innovative work many of you are doing to improve home- and community-based services and to integrate behavioral health into your initiatives. 

We’re also interested in your work to manage the needs of high risk populations – whether it’s through the work you’re doing on those eligible for both Medicaid and Medicare or through your efforts to improve long-term care and identify and better manage care for so-called superutilizers of care. 

As you continue to innovate, we’ll continue to invest at the federal level.  When I met with the governors in July, I spoke with them about an investment of more than $100 million in a new Medicaid Innovation Accelerator Program. 

We created this initiative after hearing from you that you’d like us to strengthen peer-to-peer learning and provide technical support and resources like measurement tools and data analytics. 

As a former OMB director, these are a few of my very favorite things!

Last but certainly not least, six states are testing new comprehensive delivery system approaches through our CMS Innovation Center State Innovation Model.  This is a strong partnership between CMS and states to improve care and the health of the state’s population while spending dollars more wisely. 

Over 30 states applied in the second round for more than $700 million in funding.  Ultimately, we plan to have a majority of states participate.

Efficiency, Effectiveness & Transparency

Speaking of things that are near and dear to a budget director’s heart, I’m a firm believer in impact, accountability, strong management, metrics.

So before I close, I want to recognize your work on efficiency, effectiveness, and transparency – particularly as you’ve brought new systems online. 

On the topic of enrollment systems – I want you to know that, we’re making the investments necessary to drive progress.

Specifically, and as you know, last week we announced a permanent extension of 90/10 funding.  I know all of you use the enhanced “90/10 funding” to make improvements to your enrollment systems. 

This extension reflects our commitment to system modernization—not just for this year and next year—but for the long term, and in return we will ask states to be accountable to make wise investments and achieve positive results for consumers.  We know that’s where you want to be as well. 

I also want you to know that at the federal level we recognize that your work is making a real difference.

For example, in Kentucky, almost all Medicaid enrollment applications are being processed in real-time. 

What this means is that Kentuckians now have the opportunity to start accessing services within a day of applying.  Needless to say, this wasn’t previously the case.  Think about what this means if you need to see a doctor or fill a vital prescription. 

So thank you, Team Kentucky!

I know virtually all your states are making similar progress. 

I also know there have been challenges system-wide.  Enrolling millions of new people and bringing systems online are not easy tasks. When there are technology challenges at both ends, it’s even harder.

In many cases, the best options were mitigation strategies and workarounds.  In this upcoming year, we’d like to work to move past that … To refocus on the types of systems that we all know Medicaid needs. 

And we want to be certain that whatever system issues continue through this year, that states have appropriate mitigations in place so that these issues do not have a negative impact on consumers.

I want to specifically call out renewals—none of us wants to see the impressive gains accomplished through new enrollment eroded because systems are not in place to keep eligible individuals enrolled. 

So I’d like to see regular progress as we map out longer-term systemic improvements with assurances that until those improvements are fully in place that adequate and appropriate workarounds allow eligible people to enroll and stay enrolled for as long as they are eligible.


Ultimately, these three areas we’ve discussed this morning – systems, expansion and delivery – are all connected to a single vision – a vision woven together by affordability, access, and quality.

We want every American to have access to quality health coverage they can afford.  And we want to do everything we can to help support states to meet the needs of their constituents.

Our belief is that your health care shouldn’t be caught up in red tape and it shouldn’t put your family in the red. 

So today, we want to join you in moving beyond the back-and-forth that too often characterizes our national debate. 

And we can do it together.

I look forward to continuing to work with you.

Source: hhs.gov