Remarks to an International Forum on Sustaining Universal Health Coverage

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U.S. Department of Health & Human Services
Health Resources and Services Administration
HRSA Press Office: (301) 443-3376


by HRSA Administrator Mary K. Wakefield, PhD, RN

April 2, 2012
Mexico City, Mexico

It is a pleasure to participate in this Forum, and to have the opportunity to speak about the approach of the United States toward realizing and sustaining universal health coverage.

Some of you may be aware that health care reform has been a subject of great debate in the United States during this past week.  The legal struggle in the United States to expand health care coverage to all of our people is a long story, with roots in the early and mid-20th century.  But actually achieving broader health care coverage only became a possibility on March 23, 2010, just two years ago, when President Barack Obama signed the Patient Protection and Affordable Care Act.

Let me provide just a little context on the United States health care market. In the United States, most citizens’ health care is provided through their employer, and managed by private insurance companies.  In addition to employer-sponsored health insurance coverage, two major public programs – Medicare and Medicaid -- provide health insurance to tens of millions of elderly, people with disabilities, and low-income people.

But before the Affordable Care Act in 2010, approximately 50 million Americans did not have health insurance at all.

This fragmented system was clearly broken.  Our health insurance market worked quite well for big insurance companies, but it did not work very well for middle-class American families. 

Essentially, the situation we faced before President Obama took office was one where:

  • Health insurers could choose the people to whom they gave insurance coverage, and the insurance companies based the costs of this coverage on characteristics of individuals such as a person’s gender or their health status.  That made it hard – and sometimes impossible – for families to afford the important security that health insurance provides. 
  • As a result, tens of millions of Americans were not covered by insurance, and they lacked access to basic health care services. 
  • And those that had health insurance coverage were often afraid of losing it if their employer dropped coverage, or if the individual changed jobs or retired.

So action to address these and other problems was long overdue.  This was the aim when Congress developed health reform legislation to address these issues – the goal was to make health insurance more widely available, to limit rising costs, and to improve the quality of health care.

And here’s how the Affordable Care Act – our health care law – does that:

  • It protects people from the past practices of health insurance companies;
  • The law makes health care more affordable for employees, individuals and families;
  • It provides better access to quality care;
  • And it strengthens Medicare, our public program that guarantees health insurance coverage to people 65 and over.

Let me make a comment about each one of these points. 

First, as I mentioned, it protects individuals and families from prior insurance company practices.

Before the law, insurance companies could deny health insurance coverage, for example, to a child who had asthma or a heart defect.  The companies also could put a lifetime limit on the amount of health care services that they would pay for.  That means that a person could develop a serious health problem one day, and find her insurance canceled the next – losing health insurance just when she most needs it.  Clearly, these practices were not fair.

So, basically, before the law was passed, when the 129 million people who had pre-existing health problems like heart disease or cancer tried to buy coverage on their own, they were often denied.

The health care law puts an end to these insurance company practices.  The law makes it illegal for insurance companies to deny coverage because of a pre-existing health problem.  As a result, already tens of thousands of Americans with serious health conditions across the country are getting the health insurance and the health care they need.  And now it is illegal for insurance companies to deny coverage for children up to age 19.

Second: the law helps people by bringing down health care costs and making sure health insurance premiums are spent wisely.

In the past, some insurance companies spent as much as 40 percent of the money that people paid for insurance coverage – that is, their premiums – on administrative overhead, marketing or CEO salaries.  The health care law created a new rule so that insurers must spend at least 80 percent of the money they collect through insurance premiums on health care services or on improving care – or the company must repay the money.

Additionally, the new law provides special relief for small businesses, offering them tax credits to help them afford coverage for their employees. 

Third: the law also improves access to affordable care.

For example, for years most young adults lost health insurance protection that they typically had from their family’s insurance.  They lost that coverage when they graduated from high school or college.  The law now protects these young people by permitting those who have no access to health insurance at work to stay on their parents’ insurance plans until they turn 26.  That change has already allowed 2.5 million young adults who were previously uninsured to get health coverage through their parents’ health insurance plans.

The law also expands access to preventive care.  All of the representatives here today know the importance of being able to get primary and preventive care.  All of you know that getting the right preventive care – like cancer screenings and vaccines – is an important way to stay healthy.  But before the health care law, many people did not take advantage of preventive care because it often required expensive co-payments – payment in addition to their health care premiums – that they often couldn’t afford.  And, of course, the tens of millions of people with no health insurance mostly went without these vital screenings and checkups.

The law now provides many recommended preventive services at no out-of-pocket cost to the patient.  As you know, that helps people stay healthy and avoid costly hospitalizations.  Already last year, 54 million people with private health insurance took advantage of the law's expanded coverage of preventive services.

The law also invested billions of dollars in a network of 8,500 health centers in communities across the country.  These health centers, funded in part by our federal government, provide primary and preventive care, and for those currently without health insurance, the cost they pay is determined by their income.

When President Obama took office, health centers served about 17 million patients annually; now they serve 19.5 million people.  Health centers work to control chronic diseases and to keep patients out of more expensive emergency care; they keep costs low; and more and more, they deliver care using health care teams, which improves care quality.

Each of the health reforms I’ve mentioned helps fill the holes in our existing health care system.  But they’re just the beginning.

Two years from now, in 2014, states in the United States will create Insurance Exchanges for people who buy their own health insurance – people who don’t get it from an employer.  To help increase insurance affordability, tax credits will be available to middle-class families and there will be better access to Medicaid, the health insurance program for low-income individuals and families.  And we’ll put some rules in place so that all Americans have access to a fair, transparent marketplace to purchase their health insurance. 

The last major area of improvement is Medicare, the public insurance plan which nearly 50 million older people and people with disabilities rely on each year.  In 2011, 32.5 million Medicare beneficiaries — almost three out of four of our senior citizens — took advantage of the law's expanded coverage of prevention and were able to obtain health care screenings without having to pay extra. 

The law also gives Medicare beneficiaries more help in paying for medications.

And the law encourages and supports health care providers – nurses, doctors, pharmacists and others – to work very closely with each other to coordinate care for patients.  This is especially important for elderly patients with many health problems and who often see multiple care providers.

That briefly covers the major areas in which the new health care law moves the U.S. health care system toward universal coverage.

It has been just two years and we’re already seeing that the law is making a difference in Americans’ lives.  We look forward to ensuring that all Am ericans have access to affordable health coverage, but we also know we have a lot of work to do.  We look forward to continue to learn from each of you as we work to improve the health of those in our country.

Thank you.

Date Last Reviewed:  April 2017