An hour with HHS Secretary Kathleen Sebelius

for mccain auditorium at kansas state university at our present an hour with kathleen sebelius and j mcintyre kathleen sebelius served as the governor of kansas from two thousand three to two thousand nine when she was selected by president obama to serve as secretary of the us department of health and human services this may it's the one hundred to the seventh landon lecture on public affairs series started in nineteen sixty three and five former governor tom blanton and now here is secretary of the hhs kathleen sebelius thank you thank you but when i start by thanking presidential is for a rally that nice introduction but for your leadership of this incredible university i didn't have a chance to really work with presidential city was chosen as i was leaving kansas but i'd certainly watched him in this capacity and he's doing a terrific job

and the state is not only important in a manhattan community it's one of the state's crown jewels and i think it's a it's a critically important university and to our nation and i am i'm really pleased to be here today also with lots of members of the wildcat family with the key members of the administration and faculty were supporters advisors and students on an island also delighted to be here at the home of two of the nation's best coaches bill's diner in frank martin as you know coach snyder and i had a chance to work together on lots of issues as governor most particularly on finding more adults to mentor kansas kids and he does a great job not only on the field but each and every day in communities throughout the state

and i haven't had a chance to get to personally know frank martin but i've certainly watched two men and one of his legions of fans and i had the tail watching at the game the other night few more free throws in a little mojo for jake pollen in case day can beat any team in the country no question that crow what's really impressive about the coaches is they they are both coaching kids for life skills and not just sports skills and that's really what university coaching is all about you know i'm pleased to be back here with all of you in in my new position in washington i am really guided every day by the work we did here in kansas to build a stronger healthier and more prosperous state every day of the year it's great to be here in manhattan i have a real soft spot for manhattan and for tasty i married a while

which is what brought me to kansas so it will always be near and dear to my heart i and although i'm now on the east coast manhattan to me always means kansas and not new york so i know this is a terrific place to get a college education but also it's such an important engine for our state's economy steady source of innovations and so many areas from engineering to agriculture and i'm especially proud of the work we did and the key state was selected to be the site of those new state of the art lab one of only three in the world that will put our state at the forefront of animal health research not only in the country but throughout the global community now our department hhs operate similar labs for human diseases through the centers for disease control and through the national institutes of health and i know

how absolutely critical they are to the health and security of our nation so i'm glad to see plans for this facility moving forward here in them at land and thank you so much for inviting me as you can see i still have an array of purple in my closet and it's good to have a chance to wear it once again but it's a huge honor to be invited here to give the landon lecture to be here where so many leaders have stood before in this great auditorium and of course says presidential says already sad the first of those great leaders was governor how planted himself now gonna land and had a truly remarkable like he was a great success in the oil business he fought in the first world war he served as governor of the state being ran for president and eventually became one of our nation's greatest statesman mr landon was also a fortunate enough to witness some amazing advance in history the invention of the automobile the defeat of

fascism the civil rights and women's rights movements technological leaps that put a man on the moon and gave us a personal computer but i would argue that no area is where our country has made more leaps during governor landon's lifetime ban during the last century was our move forward in the whole field mr landon was born in eighteen eighty seven and at that point the average lifespan for americans was to live to mid forties which was only about a dozen years longer than the average lifespan of the hunter gatherers who were on these planes thousands of years ago but in nineteen eighty seven land of their land and passed away just after his hundredth birthday the average lifespan of a us citizen had risen to seventy five years that's a remarkable span diseases like smallpox and polio which used to be every

parent's greatest fear or wiped out in this country conditions that it once been a death sentence became manageable and the death rate for coronary heart disease hiv drop more than sixty percent from world war two death rate for stroke was seventy percent lower than it was in the beginning about century and there are lots of reasons for those gains in health scientific breakthroughs like penicillin played a role so did public health breakthrough throughs like improve sanitation and clean water a public policy breakthroughs also helped like medicare which provided unprecedented security for half of the seniors to prior to nineteen sixty five had no health insurance at all so those gains in health really transformed our country because health is really about freedom only live longer healthier lives and get more time to do our jobs more time to volunteer in our neighborhoods to play with our children too watch our grandchildren grow up

and health is also the foundation of our national prosperity healthy adults are more proper productive workers healthy children are better students healthy families may greater contributions to their own communities so when the health of the nation improves we see the benefits each and every day in our lives and today i want to talk about some of the steps i believe we can continue to take to make progress so that we can leave a healthier country for our children and our grandchildren the most significant piece of health legislation passed in the last forty five years is the affordable care act which was signed into law last march it lays the framework for reorganizing health here as well as reorganizing our health insurance system now for years we've had health insurance market that was crumbling employers are dropping coverage premiums were

skyrocketing consumers were getting more and more frustrated and more americans were shut out price down or dropped out of the market altogether without health insurance or with insufficient health insurance too many americans went without critical care or so other savings disappearing and one accident or one family illness and without legislation that the market would've continued to deteriorate over time so the last eight months since the new law was signed our department has been working closely with governors in lieutenant governor's i try filet he's here today insurance commissioners like sandy praeger across the country as well as health care providers and consumer groups and employers to implement the first parts of this new law and while we've got a long way to go we already see signs of progress right here in kansas so in the last eight months we began addressing one of the really an acceptable gaps in the health insurance system the so called donut

hole for seniors for prescription drug coverage about nineteen thousand seniors in kansas have already gotten some help with their drug coverage with her to under fifty dollar check me on this year and next year belle begin to see a fifty percent the crabs crease in the price of those prescription drugs and then chalet that doughnut hole will be closed all together we've also establish an early retiring reinsurance program that helps employers maintain health coverage for their early retirees now right now a lot of folks are retired are yet eligible for medicare they're not sixty five yet and they rely on their former employers for insurance coverage but as health care costs rose more and more employers ended that retiree coverage which leaves folks in the early sixties with nowhere to go an individual coverage for a sixty something can be very very expensive and

so far thirty four major kansas employers and unions from spirit aero systems too sprint nextel have applied to be part of the program to keep their retiree coverage in place and that helps stabilize a very fragile part of our market and we support from our department kansas is also set up the pre existing condition insurance plan where adults who had been shut out of the health insurance market because of preexisting health conditions can now get affordable coverage on their way to twenty fourteen hour one kansans who wrote me recently was typical in his wife ran business in saliva and they bought health insurance year in year out for their employees because i thought it was the right thing to do and they wanted to keep the best employees in place and then when they retired they applied for individual coverage from the same company they'd been purchasing employee coverage from over the years but because they had minor health conditions they were denied coverage and he wrote to me and said we're worried we won't be

able to find insurance coverage at all but thanks to the affordable care act there are new options now for retirees like this couple we've created a new patient bill of rights that establishes a long overdue consumer protections in the health insurance markets in new rules about areas that i saw your inane you're out working as insurance commissioner for example insurance companies can no longer take away someone's insurance when they get sick just because of an unintentional mistaken their paperwork and last week we announce a new rules that companies will have to make sure that at least eighty cents of every premium dollar collected will be spent on health care and quality care issues now on salaries and marketing in administrative costs and there's one reform that's particularly important to students here today now we know that young adults in their twenties have had very low rates of health insurance

and twice as likely to be uninsured as older americans part of the reason it's because it's not always easy to get a job that offers health insurance ran out of high school or college i know that because when our sons graduated from college neither had a job with health insurance benefits are older son was going back to graduate school not quite sure what our younger son was doing that was to say it didn't come with health insurance but is part of the new law young americans who don't have insurance from their employers can stay on their parents' plans until they're twenty six birthday so when he's still looking for a job after graduation i'm going off to graduate school and working for small business or not for profit that doesn't offer health insurance you won't have to worry about health coverage now these reforms are not gonna fix every problem in our health insurance system overnight in fact because we didn't want to disrupt the coverage that a hundred and eighty million americans already have many of the important changes are phased in over

time in don't take effect until twenty fourteen but were starting to feel some of the biggest gaps in and some of the worst abuses and give more control to all the people who felt like there was nothing they could do when their premiums went up thirty percent or their claims were denied and as we go forward i can tell you we looking forward to working with all of our state partners to implement the law effectively and improve it along the way but contrary to the impression you might have been watching cable news there's a lot more to health and health insurance and a lot more progress being made today than just the focus on the new law so what i'd really like to do this morning is share with you six additional areas performers investments in technologies that i believe are essential to creating a wealthier country and this list is not comprehensive it's not all were doing an hhs but they help to provide some of the useful examples of a kind of war that we can do together to keep america on track toward a

healthier future and along the way they might answer another question some of you might have which is exactly what does the department of health and human services do and so let me start with medical countermeasures now here in kansas we do have a proud military tradition and there's no doubt that a strong military is still the foundation of our national defense but increasingly the range of dangers we face is widening to also include biological chemical nuclear and radiological hazards we don't know where the next public health crisis is going to come from it could be bad for a bearded dirty bomb set off in a university lecture hall it could be a natural occurring superbugs that resists all treatments it could be a biological weapon we've never seen before are assembled from the building blocks of life by terrorists and lamb in order to respond effectively when the crisis comes we need to

have in place what are called medical countermeasures the vaccines in cairo's diagnostics and other drugs and equipment that often our first and best defense against these threats now it's the same kind of response that the new animal health lab here in his state will help to identify for animal crises and were responsible for it when it comes to human health the problem right now is that there's little incentive for the big drug companies from the pharma companies to produce medical care measures for conditions like ebola virus or exposure to non medical radiation even now in the event outbreak or a nuclear explosion those countermeasures are absolutely critical so it's up to our department working with the federal government to figure out strategies to produce stockpiles of these important and borrows after september eleventh the us government come up with a plan to make up for the shortfall but we still aren't as nimble and flexible as we need to be

so over the last two years we were charged by president obama with conducting the first ever complete review of the operation to develop and produce medical care measures and we've identified a couple of key areas where we can strengthen our countermeasure pipeline for example one that we're exploring which is actually is right now on the defense community is low launching a nonprofit venture capital firm providing strategic support to the small companies that have big ideas the capital before they get that product to the market the defense department is use this strategy very effectively and some and new weapons development again and not something that there's a big market for but an important issue another areas providing additional resources to the food and drug administration one of our agencies and the national institute of health another agency making it easier for companies to produce countermeasures

and navigate the regulatory system by creating clear regulatory pathways analyzing promising new discoveries on a much faster pace and helping identify and solve the scientific problems as they occur their goal is getting great ideas from the microscope to the marketplace in a much more timely and efficient manner as all the athletes here know how well you perform in the spotlight depends on how well you practice when no one's watching so the same is true with our response to public health crisis how well we prepare now will determine how successfully we can respond when the next crisis comes and we know unfortunately that we will have a future crises so the review gives us a roadmap for improving our preparedness and we're working now with congress to fill those gaps and we need to follow that roadmap to a safer and more secure future cancer is another big challenge on our horizon we need to provide some

additional focus on the strad disease one of the changes that we've seen since the days when the land was born is that we have to worry about new health threats many cancers don't become deadly until after someone sixtieth birthday so it wasn't a big issue a hundred years ago when the average lifespan was shorter than that but now what we see is more and more people and half the man and a third of the women in the united states will develop cancer in their lifetime and that's a lot of our population and the good news is that as cancer is becoming a more frequently seen disease breakthroughs in science are giving us better weapons for fighting those cancers for years the may approach to treating cancer was similar as the scientists tell me to carpet bombing oh we're you are attacked with radiation or chemotherapy all of the dangerous cancer cells but he also

killed a lot of dead cells along with it and you just helped you were on balance killing more red cells than the bad but thanks to the progress scientists have made cracking the genetic code we now have the proper possibility of developing more effective targeted therapies for example we've got a new drug that enrages testing right now perception that can cut the risk of early breast cancer recurrence in half for patients whose tumors have a certain genetic marker image shows incredible signs of promise but to speed the development of the new treatments we've created what we call it cancer genome atlas at the national institutes of health uses funds from the recovery act and were expanding a comprehensive database of the dna changes associated with twenty major tumor types it would unleash a new generation of cancer treatments are targeted at an individual specific

tumor and we just began to travel down these research japanese but we need to keep pushing forward so that continued investment in than scientific research is so essential i just and that began the speech this morning twenty more americans have died of cancer and if we can speak up the development of the next generation of targeted therapies we could strike a huge blow against a disease that now kills more americans than any other disease beyond heart disease to be a healthier country and we need new cures and treatments that's for sure so attractive i can or measures we tracked by cancer but we also absolutely have to improve the way we deliver health care for example every year tens of thousands of americans died from what are referred to as health care associated infections more then dive from homicides and car accidents combined navies of the infections that don't take you to the hospital the sere the infections they kill or injure you once

you are in the hospital and they're one of the top ten dollars of americans today i'm back tears at johns hopkins have developed an incredibly effective tool for saving lives in hospitals and nursing homes and in healthcare centers it doesn't take a huge investment and no equipment doesn't training it doesn't personnel it's really a checklist ol protocols and procedures that have to be followed in every room every time by every provider basic steps like washing hands was so and wearing a sterile mouse doing it each and every time in contact with patients now it's hard to imagine that's such a simple procedure could make a big difference but when i was tested in michigan hospitals in use by doctors to insert captors into a major they need results were incredible in eighteen months infection rates were down sixty six percent fifteen hundred lives were saved and cost went down by two hundred million dollars just with a small group of hospitals and so to hear those numbers you

must think that every operating room known american uses checklist but unfortunately that's not the case the truth is that innovations travel way too slowly in our health care system and recent research shows that it takes seventeen years that's one seven seventeen years from the discovery of an effective treatment or protocol to be incorporated into routine patient here and by comparison for many viewed today take seconds for your friends in california until around facebook that you're in a new relationship for that it's complicated but it can take years for a hospital in california to learn how a hospital in kansas is improving care so one of the best ways we can become a healthier countries to speed up the rape which lifesaving innovations and treatments like the checklist are adopted universally and it starts with creating

incentives that actually reward better here so if you look at the new healthcare long can see that there's provision after provision that create incentives for doctors and hospitals too deliver higher quality hearing actually be reimbursed for that care and to understand the potential of those changes just think about the michigan example one quality measure one kind of procedure saved fifteen hundred lives in eighteen months and multiply that by fifty states for just that one procedure we know that we can do a better job delivering healthcare we can start to see the difference that these changes can make another area where the health industry is frankly way behind other industries in america is you saying technology another step that is going to help us dramatically improve the quality of healthcare is adopting electronic medical records for all hospitals and all doctors now any industry after industry we've seen the power of

technology bring down costs and improve the customer experience and mansions going back to the days where you were at a grocery store and somebody was he and adding all the handwritten price tags or waiting for a bank to open so you can cash or check and actually have cash for the day how we can not imagine the systems going backwards that health care is different and it shouldn't be in fact we've already seen the power of electronic health records across the country cutting health care costs reducing paperwork improving outcomes in giving patients actually more access to their own health information four months ago i was in cincinnati and i visited the neonatal board of the cincinnati children's hospital does some of the most complicated procedures in the country on these tiny infants they've done a thousand days without a serious safety incident a record they directly credited to electronic health records because every provider in touch with every baby had to code in

the medicine code in the procedure was checked on a regular basis and actually they were denied access if they report in the wrong coated the wrong time a big part of my job now is travelling around the country talking to doctors and nurses and i haven't met a single health care provider who uses a high quality alike turning health record and said boy i wish i could go back to the days where we had this great paper files it's really in on the best way to practice and yet here's where we act in this country to intend actors and one in ten hospitals even use a basic electronic medical system today how many have you gone to the school clinic in to back his office and handed the infamous clipboard where you once again record all of your health data on which somebody has on file somewhere but it's not been transferred in the years some reasons for this it's not easy to learn a new technology especially if you are a doctor in a small practice that doesn't have an it department and sometimes if your

doctor in a small practice in here somewhere in rural kansas you are the it department so there's a challenge of being able to share information with other providers securely even if they have a different system and if you can't get information from your patients other doctors electronic records lose a lot of their value and there's the fact that these systems can be expensive even if they pay off in the long run so what's happened over the last two years is an unprecedented effort to remove some of those barriers to move medicine into the technological age we've created health it regional extension centers across the country modeled exactly after the agriculture for an extension centers where their teams ready to go and he is a way of small providers and small hospitals to be the boots on the ground to provide the technological expertise we know how effective that is one teams from the farm extension service can come to a farmer's land look at the seeds they're using

look at the dirt figure out what's working and what's not and we won apply that same kind of hands on technology to the medical field and they held it centers actually provide that kind of hands on support and one of them is going to be located right down the road in topeka we're also providing grants to help states create a framework a statewide framework for docs and hospitals to exchange information with full protections on patient privacy and the good news is here in kansas we had done a lot of work in this area so we're well ahead of many states in the country and ready to go we're providing bonus payments for hospitals and doctors to adopt electronic health records and helping them to use those record keepers for improving patient here and together these investments are going to knock down many the obstacles standing in the way of building a twenty first century healthcare system using technology to improve results in lower cost just like every other enterprise the result is that doctors are

going to have more time to spend with their patients more tools to do their job of patient care more ability to court made that patients here and america actually has a great opportunity to be a world leader in one of the growing industries of the future the technology of health information we know again that health and wellness is important it's an important building block if we want to help your country we can't just focus on what happens in a doctor's office so when you get to the hospital we also need to pay attention to the air we breathe in the food we eat and the lifestyles we live right now in america we have an obesity epidemic two in three adults in america and one in three of our children are overweight or obese this isn't and fashion crisis it is a very serious health crisis obesity brings with it a far higher risk of heart disease and stroke and certain cancers and it's the biggest predictor of diabetes

which can have crippling effects throughout the life and that's why the administration has launched a really broad agenda to help americans make healthier choices from the first lady's let's move campaign to the investments we're making in some of the most promising community strategies for reducing obesity like bringing supermarkets to food deserts and for a farm economy like kansas linking local grocers to purchasers can not only improve health but also help of an economy in the first place one of the biggest obstacles we know to eating healthier choices is knowing really what foods are the healthiest now most people know that fresh fruits and vegetables are better than a cheeseburger and french fries might not taste better but they are better for you ah but it's hard to guess that a tuna melt from a fast food chain has more fact than a stick of butter if you would sit down and just eat then it's your

kitchen table would pick out the healthy serial from an array of fifty choices why you could go to her food chains website or tried or read their tiny nutrition facts on the back of packages most people don't have the time and frankly they don't have the interest but we now bad giving consumers some additional tools and some information about the foods they eat can be helpful and so part of the affordable care act will have chain restaurants began to display calories for the different offerings on their menu some people actually get a chance to see what choices they're making were working with food manufacturers and grocers to put easy to read easy to identify labeling on the front of packages so when you go to the grocery store after a long day of stunning work you actually can figure out much more easily what is the healthier option the truth is that most

folks really want to eat healthier diets maybe not an anti villain three am but most of the time you want to eat a healthier diet but that challenge is to make that healthy choice more convenient more affordable more easily accessible and that's really what we're trying to do violinist than a minute just talking about food safety at the same time were working on keeping americans healthier we need to put a new focus on keeping our food safe an area that as presidential says is one the hallmarks here at kansas state university every year millions of americans suffer from foodborne illness hundreds of thousands are hospitalized and thousands of people die and the way our food safety system works in america today doesn't make a license local health officials begin to see an up people getting sick and they might suspect of foodborne illness mainland notify

our regional folks at the center for disease control that something is going on who then send investigators are trying to pinpoint where the outbreak is eventually the food and drug administration is notified they investigate the source and may begin to war in the country about the food of concerned still the food and administration has no recall powers of its own they can provide a warning but they can't get the food mandatory weight off shelves that's a voluntary activity in other words we're still working backwards we chased the outbreaks after they occur and we're trying to always scrambling to catch up with what's making people sick not only does it cause a lot of anxiety and confusion for consumers who are shopping and trying to figure out what's going on it also causes major disruptions in economic losses for farmers and producers every time someone gets a tainted food products people get sick

the entire industry suffers in farm states like kansas we understand the importance of a safe and secure food supply better than anyone and we've seen firsthand how producers can take a huge economic loss if folks are scared away from buying a product even if there's no scientific evidence behind it so the problem is that we've been monitoring and twenty first century food system with twentieth century tools today nearly half of our fruit in order over three quarters of our seafood comes from overseas whether its tropical fruit from mexico are chilean sea bass that you enjoy in a restaurant but many of the importers don't have the same strict food safety standards that we have here in the united states and as the phone system has evolved our methods for monitoring what's being served in people's kitchens has not the last significant food safety related changes and the food drug and cosmetic act took place in the late thirties before many of the students

grandparents were born and so one of the biggest challenges as secretary of health and human services has been working in close collaboration with agriculture secretary tom vilsack former governor from another farm state of iowa to build a twenty first century food safety system it's been a top priority of the president and we want to move forward with a system where we can prevent outbreaks in the first place or catch them early much closer to their source and give people the information that they need and every step along the way there's legislation pending right now in the united states senate that would be the biggest update to the food safety efforts in decades and we hope it will pass so so that we can start reducing these preventable deaths so i've just talked about six serious steps we can take to become healthier country strengthening our medical care measures and pipeline resist suing targeted

therapies against cancer reducing health care associated infections switching to electronic health records putting better nutritional information in people's hands and building a twenty percent tree food safety system and they're all top priorities for our work on areas where were either currently making or plan to make significant progress there are also holes that most americans can support making sure we have an adequate supply vaccine injury barrels for the next public health crisis isn't a democratic strategy are republican strategy it's an american strategy than if a food safety bill has strong support from both parties we can all get behind saving lives and lowering costs by reducing hospital errors and yet you rarely hear about those stories in the newspaper and that's not surprising bell always be more coverage of political battles than on areas where there's a lot of agreement a plane crash that kills two hundred people will always be a more dramatic story than a

hospital checklist that saves two thousand lives but it's important that we don't lose sight of these opportunities because of these steps and steps like them that will determine whether we continue to make the same kind of gains in health care that we have made over the last century we should never fall into the trap of becoming convinced that progress is guaranteed recently there's some pretty dire news on the horizon experts have said that we are raising the first generation of american children and two hundred years to have shorter lifespan than their parents and after the enormous gains we've made in health during the last century our momentum is in danger of slowing to a halt and even reversing but it doesn't have to if we work together in the areas we agree on compromise in the areas we down and make health a top national priority i'm confident that the students here today will be able to look back at the end of their lifetimes as did governor landon at the end of his and know that they're leaving their children and grandchildren a

stronger healthier and more prosperous america thank you so much for having me here today you're listening to kathleen sebelius secretary of the us department of health and human services and former governor of kansas she spoke november twenty ninth two thousand ten and kansas state university civilians now takes questions from the audience writes on the president he gets the tough questions those i welcome back to kansas and one of the pediatricians are entailed end of our injured your presentation greatly but in view of the election that just occurred that feeling throughout the country that dissatisfaction with the health care bill the fill the bill will be repealed or he thought would be

amended promised their problems with the bill as it is written and if you can spend some time addressing that one other question how much of the bill there's a human health services actually have input into the legislation when it was finally written and maybe you know for sure there are lots of features of the bill i would say it's it's basically two parts of the insurance market changes which some of the immediate changes i addressed earlier and builds over time to a new state run health insurance exchange which actually again how as i think broad support when people understand what it is set to replace the parts of the market particularly for individuals buy their own coverage and small business owners a way they can be in larger pools and have more competitive choices a state run program and what we're doing right now is working i with governors in insurance commissions around the country to

make determinations of whether or not they want to run those exchanges i the rest of the bill deals with a lot of the healthy underlying health changes more investments and workforce is you know we got enough primary care backs we've gotten enough pediatricians injury intelligence or there's a major investment in the workforce there is a major investment in community health centers and build double and time over the course of the next ten years there are incentives in place so we can use the public payment system for medicare and medicaid to begin to make some of that changes that we've talked about so i thought i don't have any question that the bill is likely to be changed over time i think that talk about repeal and it is one that the new congress will decide the votes are probably in the house of representatives to pass a vote to repeal the bill and i don't think they are there in the senate i don't think the president would sign a bill that repeals the healthcare act so in the meantime i think the work on on making a better medicare past forty five years

ago doesn't look much like they did when it was originally passed it set a platform and i think they're going to be lots of areas that we can work on together but most people who i tracked to once they listen to the features of the bill while a lot of those improvements to go forward so i think they'll be a robust debate we've set a platform and will continue to be implemented that it to your final question how much input there were five committees in congress to in the senate and three in the house you actually had drafting a gurney and roll parts of the bill but we were certainly very gates involved than i can say we're from center in the implementation they're about three thousand references in the bill to the secretary shall dot dot dot and that happens to be me its case against i'm a psychologist practicing in the state of kansas and my question is about medicare and i'm aware of the nursing home lobby i was

wondering if you were planning on any changes in the way medicare is implemented so that more people are supportive through medicare for staying in their homes as opposed to a nursing home well actually manage here itself as you know does not have a long term care component most people who end up on public assistance and the last days of their lives medicaid eligible and that often is what pays for nursing home care gary is a major project underway and actually we do our work on it again here in kansas and that work is really expanding our site which is called the money follows the person we are an effort is being made to the bill much more kind of continue of tear in communities and that's one of the missing pieces you can't really have folks stay in their

home communities and last they have services available many people would much rather preferred be independent for a lot longer period of time some need help with activities of daily living hell making onshore to make sure that they are i'm being i'm here for adequately or they take their man so those programs are really being looked at and a lot more resources are being shifted particularly to states like kansas who has began to build that continuum hear another piece of the affordable care act is the so called class legislation one class does is set up a volunteer e employee checkoff we're an employee over a five year period of time can bill and they essentially a savings account of their own to then use for a whole variety of community care services it's not a long term care insurance policy he really recognizes that a lot of people would like to have in a residential care home health care opportunities to stay in their own homes and

that is part of the system were looking at the aging in place is one of the i think hallmarks of i am a lot of the legislation will mean for because people would really prefer to do that and the good news for kansans is they kept it really knew was that the secretary aging here in kansas and worked in our administration is now the assistant secretary for aging in washington she brings and that sense so i think community service with iran has done a lot to begin to transform that agency which is also under our office and my question is was regards to the constitutionality or firstly as i like you talk about the requirements of someone that doesn't have health insurance what they're going to require added two thousand fourteen and then whether the cost is still managed to be connected and possibly get more lawful orders were they in twenty fourteen and the assumption is that in order and to

have really a a viable insurance market you need everybody and so if you get rid of the the rules for insurance companies that say you can't any longer a lemonade people because of their health conditions we have to have a mechanism to make sure that healthy people as well as sick people buy insurance or nobody would bite until they get sick and then you would have a totally unaffordable system i think the best comparison probably is if you think about car insurance if you were only buying car insurance once you have a rat and you'd have a pretty unstable marketplace you really mean you know people in the system so that theory is that everybody has responsibility employers i who have fifty or more employees are armed going to be expected to provide insurance coverage for their employees or they will pay into a pool recognizing that those employees are often now and getting taxpayer supported insurance

coverage or their kids are so kind of a pool that pays that the taxpayers those in a medicare will be in place medicaid would be expanded to cover people up to one hundred and thirty three percent of poverty levels and the final pieces if you are an individual without a financial hardship exemption and you will have an opportunity to port purchase affordable coverage of the larger pool you'll have financial subsidies that will be available to you but it's a joint responsibility notion that everybody comes into the pool and coverage will be offered by private insurers in a state run exchange system there are challenges that are being brought now that piece of the insurance bill whether or not it is constitutional to say that individuals must have health insurance and the real issue is whether or not the commerce clause gives

congress that authority to affect issues that deal with insurance in say there's a lawsuit in virginia one in florida one in michigan the only ruling so far has been a michigan federal judge who said that on the merits that he found the individual mandate to be constitutional he said yes it is the virginia and afford a judge had not yet ruled they have had procedural motions but those rulings are likely to come and my guess is the case will work its way up into the supreme court because this is a fairly novel point in law and that the assumption is that if you have a functioning insurance market and you must have folks too that are sick and media coverage to pay for long term illness and people who are actually purchasing coverage too maybe sick at some point in their lifetime and in the meantime what we have as taxpayers essentially footing that bill if you have health

insurance today you're paying about a thousand dollars additional for your health insurance for the healthcare delivered to folks who i don't have healthcare could you pay more for hospitals to pay more for your doctor visits and you pay more as taxpayers for the system of support for folks who are coming through emergency room doors about fifty six billion dollars a year in uncompensated care just in hospitals along so those cuts are now being shifted into certain pain groups and this wood this would have a personal responsibility piece of that puzzle last question good morning secretary thank you for coming back to kansas point president shall i have that too i have a dual role in serving as the executive director for the kansas african american affairs commission and also serving on the kansas board of regents so my question is given the health care reform act the changes that have taken place that would not allow us to leverage some of our resources in order to improve health status i see a movement away from disparities and really

understanding disparities as they are impacting our health care needs as well as our system what will happen given day at the office of minority health and how that impacts our focus on disparities and separately we celebrate some of the things are taking place in our region system with regard to preparing our students to become professionals that are needed in the future to address some of the health care needs what are some of the other things that you would recommend to the state of kansas in our educational of secondary education system to be blocked ear or phrase about thank you for your dual service sign both of those sound efforts are incredibly important now in the african american commission to the board of regents sound is a huge hugely important role so thank you for doing both on the health disparity issue is one that i think we absolutely need to

continue to focus on and there is a major gap in delivery of health services and access to health services and in frankly the kind of treatment you get out when you access the health care system and depending on your race and ethnicity and economic status and we're spending a good deal of time and energy looking out where those gaps are first of all trying to fill the access gaps i mentioned the community health center i am size and the fact that they'll be more community health centers which anomaly in urban communities but often in rural communities places where folks do not have access to a primary care provider and in that gap it used to be filled we're looking very carefully at what are their research issues that we can learn about why there is such a disparity an adult males in diabetes rates for instance and then spend more time and energy it will

help to have everyone with some insurance coverage no doubt about it that make a major leap forward but having insurance access doesn't necessarily guarantee healthcare access are particularly on healthcare access that is equal so a lot of time and energy is being spelled looking at the data that indicates what some of the barriers are we know someone and buries its workforce are having a culturally competent workforce and having a workforce that is more diverse than the workforce current day is important so they are also efforts to recruit more minority providers to recruit providers who speak languages other than english to make sure that healthcare delivery can connect with communities that were trying to breach and that i think will will continue

but you know if you look at the economic data in this what has been the worst economic downturn since the great depression the one industry that continues to grow is health care and so if your students are looking at the future or whether it's to be a direct care provider at any level you know everything from certainly doctors and nurses and nurse practitioners end i am specialist to community health workers are being hired and trained in communities across the country because we have an aging population and because we have a system there were trying really to shift from a sick care system to a more a health care system focused on primary and preventive care in the first place so the whole spectrum of health workers is going to grow we talked about health technology there are a huge number of great job possibilities in in that ariane we have one of them you know we have server break

here in the kansas city area which is one of the international leaders in health information technology before it was cool they were talking about it but if the united states actually engages it in this electronic health record that will be a growing area and i think it you know the research possibilities that we talked about certainly the research and science thing done everything from medical countermeasures to lifesaving drugs is a huge growth area as we've unlocked this human genome the national institutes of health is now headed by our director francis collins who won a nobel peace won a nobel prize in medicine for his work in mapping the human genome he's the head of our research division and the work that's going on for researchers and trying to unlock the possibilities of q words based on what we now know about dna is extraordinary so i'd say any number of those health areas from

basic technology care workers specialists is going to be a growing area an american demand well into the future works originally coming out today and please join me and it once again best futures heard kathleen sebelius secretary of the us department of health and human services and former governor of him says she gave the one hundred fifty seventh landon lecture on public affairs at kansas state university's mccain auditorium on november twenty nine two thousand ten i'm j mcintyre k pr present is a production of kansas public radio at the university of kansas working on your holiday shopping list how about the kansas notable book eats here at the cancer center for the book at the state library of kansas releases a list of the best

books about kansas or written by kansans and j mcintyre it talking to many of the canvas not want others and next week at our present and we'll hear excerpts from their putts ball rose to his feet and stare down a curiously she looked ridiculous to him who would wear such a weird looking donald's word suddenly cotton his throat as he felt the smallest vibrations during his toes whoa he whispered the sensation was growing stronger moving gradually up his left leg now followed by the surprising overwhelming fear of despair to a mumble yes though i actually prayed yes i hear it takes the stars explosion to make gold that much heat is needed we too are all otherworldly there must also be startups and asked the morning sunlight was in their eyes as emil steered the truck out of the garage and almost immediately there was the sound of an explosion they watch the sky for smoke and finally spotted the dark

cloud as it rose from the part of town where india lived hard having never left the flint hills of kansas i knew what it was to work hard to be frugal i expected to little of others perhaps but i also knew that the desire for future the gift of an education the joy of learning and dividing strength of the human spirit which is a strong and steve as the prairie grass will hear fiction nonfiction young adult literature poetry and even a picture book for the very young readers on your shopping list joining for a look at the kansas notable books on next week's katie our percents if not next sunday evening on the company it's been it's been nice