HHS Chief Takes On Health Care Challenges Health and Human Services Secretary Kathleen Sebelius is moving forward with implementing the health care overhaul signed into law by President Obama in March. Sebelius says she hopes the law will make health care more affordable.

HHS Chief Takes On Health Care Challenges

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TONY COX, host:

This is TALK OF THE NATION. I'm Tony Cox. Neal Conan is away.

Health and Human Services Secretary Kathleen Sebelius has several hurdles ahead of her, none bigger than implementing the huge and still controversial health care overhaul signed into law by President Obama in March.

In addition to shepherding the president's new HIV/AIDS strategy, ironing out the final details and promoting the Affordable Care Act, and tackling health care issues for schoolchildren, she is battling on several fronts over the health care plan.

Missouri votes on a measure today that would stop key parts of the law. A Virginia judge yesterday allowed a lawsuit to go forward challenging the Obama health care plan, and 20 other states are working to stop the law in various courts.

In a moment, Secretary Sebelius joins us to take your calls. Later in the show, we check in on the Gulf Coast, where hopes are higher now that the leak seems to be a thing of the past, but what about the seafood? Is it safe to eat yet? We'll find out.

But right now, Secretary of Health and Human Services Kathleen Sebelius. If you have questions for her, our number here in Washington is 800-989-8255. Our email address, talk@npr.org. And you can join the conversation at our website. Just go to npr.org and click on TALK OF THE NATION.

Secretary Sebelius joins us now here in Studio 3A. Welcome, Secretary.

Secretary KATHLEEN SEBELIUS (Department of Health and Human Services): Thank you, Tony, great to be with you.

COX: It is nice to have you. Before we get into the calls and some of the questions, let me ask you to start us off with this. What do you think the American public, the people, are most interested and most concerned about with respect to their health care and particularly this health care reform package?

Sec. SEBELIUS: Well, I think most people start with how is this going to impact me and my family. There's nothing more personal to folks than health care: taking care of their kids, taking care of their parents, taking care of themselves.

So people with insurance want to know: Will I keep the plan I have? Do I get to keep my doctor? Is there going to be some change, if I like what's going on, that I don't like? Folks who don't have coverage at all want to know how soon they may have access. Is there going to be an affordable choice? And seniors want to know how it affects Medicare.

So people really start a conversation about health care from the point of view of how does the bill that Congress passed, that was debated for well over a year, that the president talked about for two years on the campaign trail, how does this actually work, and what's going to happen to me?

COX: We're going to spend a great deal of this time that you are with us talking about that, I'm certain, and I know that the phone calls are going to be coming in very quickly, and people are going to have more questions about that.

So let's talk about something before we get to that. One of the things that you are dealing with, the latest news coming out of the administration is this new HIV/AIDS strategy, which has been touted and criticized, which I suppose is the way things work here inside Washington. Tell us about that strategy.

Sec. SEBELIUS: Well, what has happened, Tony, is a group has come together having lots of conversations across the country with providers, with AIDS patients, with families, with community leaders, to talk about how we can really again focus attention in this country on what is a very serious epidemic, in spite of the fact that we now have very effective antiviral drugs.

That may be a good news/bad news. The good news is people are now not sentenced to death when they get diagnosed with AIDS. The bad news is, it has I think made a lot of folks more complacent. Testing levels have not gone up. We are still seeing about 10,000 new cases a year. We've sort of flattened out in terms of our aggressive tactics.

So we want to focus the resources, focus the energy, focus the strategy on both what we know works and get people's attention again to get tested, knowing that this is a very serious disease.

COX: This is TALK OF THE NATION. I'm Tony Cox, sitting in for Neal Conan, who is away. We are talking with Health and Human Services Secretary Kathleen Sebelius, and if you'd like to join the conversation and ask her a question, you can call at 1-800-989-8255. The email address is talk@npr.org.

We have a phone call, so why don't we go to this to get us going? This call is from Beth, I believe. Beth joins us from - well, I'm not sure how to pronounce that city in New York, Beth. How do you pronounce that city?

BETH (Caller): It's Schenectady. That's okay.

COX: Okay, Schenectady. Oh, somebody wrote it phonetically for me. That's really cute.

BETH: Yeah, where radio started.

COX: I got you. You're on the air with TALK OF THE NATION and Secretary Sebelius.

Sec. SEBELIUS: Hi, Beth.

BETH: Hi. I'm going to try to make this very succinct. I'm one of those people without health insurance.


BETH: But I also live with relatives, drive a 20-year-old car and, you know, have borderline malnutrition. So when you tell me that I have to go out, and I'm over the poverty line - so when you go out, when you tell me I have to go out and buy health insurance, that's literally food out of my mouth.

And I was going to say, Suze Orman has covered a very similar topic. Someone called in. They wanted to do something like a placenta health or something for their children, and Suze looked in their - it was a very serious issue, something extra, health care issue-wise. And she looked at their finances and she said, you know, you don't have enough money for living. You worry about that down the line, but you have to have enough money to survive on.

And that is my concern with this law. Most of us, people who work in gas stations making eight, 10, 20 - up to $20 an hour, will be deciding between, which I'm already doing, and we already are, food, shelter or buying a health insurance plan which we will not be able to use.

COX: Well, Beth, let me jump in to give the secretary an opportunity to respond to that. Thank you for the call, by the way.

Sec. SEBELIUS: Well, Beth, I think, has raised an important point, and it really needs to have some understanding of the way the law is constructed. Tony, a lot of people, what we find, want health insurance right now but can't afford it, or folks like Beth who, you know, is barely getting by.

So the new bill, starting in 2014, does have an individual responsibility clause. It applies to people who can afford it. So there is a hardship waiver that people will not have to purchase insurance if they cannot afford it.

But even better news is that there is a subsidy for lower-income working folks, for lower-income Americans to be able to afford coverage. So they may - in Beth's situation, if she's at about the poverty line, she'll be automatically eligible for Medicaid in any state; 133 percent of poverty and below is eligible for Medicaid. Or she's eligible for a new health insurance exchange, state-based exchange, with a heavy subsidy, depending on income level, from the federal government.

So for the first time ever in the history of this country, not only will the markets open up, not only will we have competitive choices, but you'll have some very serious assistance from the federal government with a hardship waiver if you still can't afford the coverage.

COX: That mandated coverage is at the crux of the court case that was being filed - that was filed in Virginia and is winding its way through the courts, I presume, in 20 other states. And it's also at the crux of an election just today in Missouri. Are you confident that it will be able to withstand constitutional muster?

Sec. SEBELIUS: Well, I'm not a lawyer. Let's start there. But I do get briefed on a regular basis by the lawyers from the Justice Department, and took a strong look at this as the bill was being negotiated in the House and the Senate. And I am confident that it stands on strong constitutional grounds.

The grounds are based on the interstate commerce, on business moving back and forth, and the fact that the federal government has a right to essentially make the rules for interstate commerce.

But what we know - again, on a personal level - is that everybody who is purchasing insurance right now is paying additional for their insurance coverage for all the folks who don't have insurance, who come through the doors of an emergency room, who access a clinic, who end up - it's approximately $1,000 a family added on to the cost of everyone's insurance to pick up those extra costs.

And we also know that taxpayers pay a big share of that burden. So right now, people are paying the cost for folks who are just opting in and out of insurance when they get more seriously ill or picking up a hospital stay for somebody who could afford coverage but chooses not to get it.

So there is an individual responsibility piece here, but also a notion that, you know, lots of folks are going to need some help paying for coverage, or we need to have a hardship waiver at the end of the day, and that's all part of the law.

COX: One of the things that also is a part of this at the moment, we have an email that is part of a question, in fact, that I was going to ask you myself, because as a former governor of the state of Kansas, you are dealing with governors right now, helping them to try to implement this, trying to convince those who are not convinced yet that it's the right thing to do.

And this question comes from Topeka, Kansas, from Bob. He says: How has your experience as governor of Kansas prepared you for your current job as secretary of HHS? And if Bob wouldn't mind, I would like to add this to his question: How would you deal with this if you were still in the governor's chair and you had to implement it?

Sec. SEBELIUS: Well, Bob, I hope it's not as hot in Topeka today as it was heading this weekend when I was home. But being a governor is a great training ground for being a Cabinet secretary.

I had a cabinet as a governor. I am now part of a cabinet with 11 agencies under the umbrella of our department, so a lot like the cabinet I used to have at home.

I worked with a legislature. Now we work with Congress. I, you know, managed a budget, do the same kind of thing. So it's - there are four former governors who are members of President Obama's Cabinet, and I think it's a great background and experience to have had to serve in this capacity and now turn around and work with my former colleagues as governors.

This is a pretty state-friendly piece of federal legislation, where the assumptions at every point along the way is that the state's going to run the plan, unless they choose not to do that, and then we step in. But this is not the federal government taking over health care. This is a very state-driven health plan.

COX: And you would feel that way even if you were the governor and it was being presented to you the way it's being presented to your former colleagues?

Sec. SEBELIUS: Well, I start with that framework when I talk to my friends and colleagues. Because I was a governor, I think I was able to influence a lot of the legislative decisions so that insurance regulation - I used to be one of those too - I was the state insurance commissioner in Kansas.

So insurance regulation is still very much within the hands of the state. We know that that's the best place for it. We're giving resources, extra resources, to states. The exchanges, when they're up and running in 2014, this new marketplace where people will have some ability to find available coverage, and small business owners and individuals will have a pool that they've never had before, that's a state-run program.

The new high-risk insurance plans are being run at the state level. So this really starts with the states in control of their own market, their own insurance ideas.

COX: We'll continue that, and also we're going to talk about - there are a number of callers who want to talk about Medicare and some other things. We'll get to those calls in a moment. We are talking with the U.S. secretary of Health and Human Services, Kathleen Sebelius. This is TALK OF THE NATION from NPR News.

(Soundbite of music)

COX: This is TALK OF THE NATION from NPR News. I'm Tony Cox. We're talking with Kathleen Sebelius, the United States secretary of Health and Human Services.

To give you some idea of the scope of her job, Secretary Sebelius oversees a budget of some $900 billion. The department that she leads handles everything from Medicare, Medicaid and the new health care law, to programs that prevent child abuse, improve education and plan for national emergencies. The alphabet soup of agencies under the HHS umbrella include the FDA, the CDC and NIH.

If you'd like to talk with Secretary Sebelius about the health law, the president's new strategy for HIV and AIDS, or her many other roles, give us a call - the number, 800-989-8255. The email address is talk@npr.org.

Before the break, Secretary, I told you I had a question about Medicare that came in, but before I give you that one, let me say we're getting a lot of calls with people who want to have their own personal health care questions answered, and obviously, you're not in a position to be able to answer each one of those. But could you provide some direction for those people who may not get a chance to ask their particular question?

Sec. SEBELIUS: Sure.

COX: Where should they go to get the information?

Sec. SEBELIUS: Well, Tony, we have a great new website, healthcare.gov. Healthcare.gov just got up and running a couple of weeks ago, and it's part of the Affordable Care Act.

So when you go to the website, it asks a few questions about where you live and what age you are, what your health status is, because those determine what your options are right now in the insurance market.

And very quickly, and for the first time ever in history, we have pulled together all of the private programs, all the insurance policies sold in your area that's suitable to you, contact information, as much information as we can. By October we'll add price information - we don't have that quite yet -and all the public programs that you may be eligible for, so Children's Health Insurance, or if you're a vet where the TRICARE services are, Medicare, Medicaid - that never has been pulled together. We also have a timeline of what's going to happen with the Affordable Care Act, what new features are going to be up and running, lots of great health information on prevention and childhood obesity, contact information. So healthcare.gov is a great place to start.

COX: All right, let's go to the email that I talked about, and thank you, Beverly in Las Vegas, for sending this in: When will the changes to Medicare Advantage kick in, and how will that affect me as a Medicare recipient? How will my costs rise? My Medicare co-pay on prescriptions have already gone up by double and in some cases triple, and the health care bill has not even begun.

Sec. SEBELIUS: Well, Beverly, as you say, if your co-pay has gone up, if your Medicare drugs have gone up, that has nothing to with the Affordable Care Act. That has to do with rising costs in the marketplace, and it's one of the things we're going to pay a lot more attention to as we move forward.

In fact, one of the benefits to Medicare beneficiaries is going to be closing the so-called doughnut hole, so the gap that now too many beneficiaries reach when they have purchased about $3,000 worth of prescription drugs, and then they're entirely on their own to do that out of pocket. So this law closes it over time.

Medicare Advantage programs, which are a choice that beneficiaries can make -do you want to be in traditional Medicare, or do you want a Medicare Advantage program - will still be very viable, up and running.

We're getting the bids right now for next calendar year. We'll have some information out to beneficiaries in later this fall about what their choices are.

We told the plans that we are not going to make cuts in calendar year 2011. We think they'll have lots of choices at very affordable prices, and 75 percent of the people who choose traditional Medicare will also have some new benefits: no co-pays for preventive care; yearly Medicare preventive checkups, which now are not part of the plan; no co-insurance for various components, and closing the doughnut hole. So there's some very good news for Medicare beneficiaries on its way.

COX: Here's another email. It comes from Dave: I am healthy, a cyclist and a rock climber. The funny thing for me is that I have to pay for special insurance plans because I climb rocks. That is to say, I get punished for doing the things that keep me healthy and sane.

Now my insurance is going up another 20 percent this year. Will this bill prevent insurance companies from including these crazy policy riders, and when will rates start coming down? Dave, thank you.

Sec. SEBELIUS: Well, Dave, I think that I'm not quite sure about the kind of policy you have right now. What I can tell you is that in 2014, with the new state-based exchanges, we will have some new insurance options, more affordable coverage.

Lots of folks - I don't know if Dave's in this situation - but if you're a small-business owner, if you're an individual purchasing a policy, if you're part of a farm family, you right now have very few choices. And you pay 20 to 25 percent more than the folks who are working for a big employer, who's got some negotiating power. That's what will change.

Not only will we not eliminate people with pre-existing conditions, you'll be able to get into an insurance plan, but you'll also have a bigger pool, have some leverage. And those rates are going to be pre-negotiated. So you'll have some choice and some competition. And lower-income Americans will also have some help paying for that insurance.

COX: If you are just joining us, you are listening to TALK OF THE NATION. Our guest is U.S. Secretary of Health and Human Services Kathleen Sebelius, and we are talking about health care.

Here's a call that we can take. This is Frank from Charlotte, North Carolina. Frank, welcome to TALK OF THE NATION.

FRANK (Caller): Madame Secretary, Tony, how are we doing today?

COX: We're doing fine.

Sec. SEBELIUS: Pretty good. How are you?

FRANK: Good. I'm - me and my wife and my child, he's a year and a half, and I'm doing the right thing by him, and I buy him health insurance. I can't afford it for me and my wife, and I work for the largest trucking company in the United States of America.

I can't afford my company health insurance on a weekly basis as it is now. I've gone through the website. I punched all the information in to - the different calculators, and everything comes back to where my company offers health insurance, that's what I'm going to be stuck buying.

If I can't afford it now, how am I going to be able to afford it in 2014 when I have no choice because that's what they - my company provides it, and I'll have no choice? I mean, what's going to be done for people in that situation?

COX: Frank, thank you for the call. You know, I bet there are a lot of people who think and wonder just like Frank, Secretary, about that.

Sec. SEBELIUS: Well, I'm hoping that the situation Frank describes, where there's an employer policy, but it's not affordable, hopefully we'll be able to impact by first having some competition in the marketplace. I mean, one of the things that's happening is that too many times in North Carolina, where Frank is, or other parts of the country, one insurance company has the whole ballgame.

And they - rates keep going up, often by double digits, and employers over time have shifted a large portion of those costs to employees. So employees' co-pays go up, employees' co-insurance goes up, and yet they're getting less and less bang for their buck.

So having a competitive marketplace, having a spotlight on that marketplace, I think in and of itself helps. We've already seen some people withdrawing rate reviews.

We're asking state insurance commissioners to ramp up their efforts to really regulate these rates, look at what the underlying costs are, and a feature of the law may be very helpful to Frank is that one of the things that insurance companies are going to have to start to do is comply with what's called the medical loss ratio.

So 80 percent of all the premium dollars are going to have to go to pay health costs, not overhead, not CEO salaries, not advertising. We know there are a lot of policies out there right now that don't meet that ratio, where the profit margin and the excess administrative costs well exceed what people are getting.

If the rates are too high, don't meet the ratio, the customers get a rebate. So there's some strategies in this law which will, I think, really help overall bring some costs down and hopefully make that policy a lot more affordable.

COX: Would a person like Frank or someone similarly situated, would they be eligible for the exchanges? And how does that work?

Sec. SEBELIUS: Well, if the employer coverage, and there is a - there's a formula that's in the bill - if the employer coverage is more than a percentage of Frank's income, then he would be deemed - if he doesn't have affordable coverage through his employer, he would be eligible for the exchange.

And that's a formula that the state would take a look at, see what his income is, see what he's being charged. And if he's eligible, he not only could go into the exchange but may well then get a subsidy to help him pay that portion of the premium in the exchange.

COX: All right, we have another caller. This is Tony in Sioux City, Iowa. Tony, welcome to TALK OF THE NATION.

TONY (Caller): Hello, how are you?

COX: Fine, how are you, sir?

TONY: Good. You know what, Frank's - she just answered Frank's question, and it's just what I had. I was just kind of curious about that myself. I mean, I currently work for a small company, and we're paying quite a bit every week, and I had the same question.

I mean, I don't like the coverage I have. It's expensive, and I want to be able to shop around for this.

Sec. SEBELIUS: Well, in small employers, in your situation, and Tony didn't tell me how big or small the company was, or maybe he did say he was with a big company - small employers will also be able to shop in the new exchange. I think that we forget that, you know, often the mom-and-pop operators are really trying to do the right thing by covering their employees, but they have very few choices at often 25, 20 to 25 percent higher than the big guys.

So the exchange - the whole idea of exchange is a much larger pool, much more purchasing power, much more leverage on getting discounts on hospital beds and provider rates and drugs, and therefore passing those savings on to employees. So in your situation, you know, your employer is going to have a chance to come in to a very different marketplace.

COX: Here's another call. This is Jerry(ph) from Cookeville, Tennessee. Jerry, welcome to the show.

JERRY (Caller): Hi, Tony. Hi, Secretary Sebelius.

Sec. SEBELIUS: How are you?

JERRY: Good. Hey, I was just wondering why so many people are just adamantly against this. And several weekends ago, there was a convention in Las Vegas. It was called Netroots, I believe the name of it was.

Sec. SEBELIUS: Right.

JERRY: And Speaker Pelosi and the president, they had taped messages that they sent, and Majority Leader Harry Reid, he spoke there. And they all mentioned that they haven't got there where they want to get yet, but we're going to get to the single-payer option and other things that they wanted to get through.

Now, I looked at their website and then I went to Communist Party USA's website, and they almost mirrored each other on their agendas. I think a lot of people find this kind of frightening.

COX: All right, thank you for that call.

Sec. SEBELIUS: Well, I'm not quite sure, since I wasn't at Netroots, what exactly was said. What I do know is that the president made it very clear that while there were people who wanted to start this conversation on affordable health care with a single-payer plan, he did not think that was a good idea. And that's why he promoted the bill that he did, which basically starts from the premise that we've got about 180 million people with employer-based coverage.

What we're trying to do is stabilize the coverage, lower the cost, stabilize the coverage for those who have coverage that they like and have a plan that they like. And then provide private insurance market options for millions of Americans who currently don't have coverage that either they can afford or coverage at all.

So this is very much a plan built around private insurance market strategies. It is not a single-payer plan. Although there were clearly members of Congress who would like that, that is not what was passed. That is not what was signed into law.

COX: Here's another email, and as a matter fact, Secretary Sebelius, it is another question from listeners - our listeners are really on it today - that we had intended to ask you anyway. And it's about misinformation. You know, you go back to the talk about the death panels, et cetera, et cetera, et cetera.

This question comes from Tamara(ph) in Holland, Michigan. She says: Every other day, I see something or someone posting misinformation regarding the Affordable Health Care Act. What are you doing to combat that? And I would add this to her question. What would you say today is the most significant or most troubling piece of misinformation that continues to swirl around in the public's mind about health care reform?

Sec. SEBELIUS: Well, I think there, unfortunately, is still a lot of misinformation, Tony, the notion that somehow people even if they can't afford coverage are going to have to buy coverage. That's just not accurate. That, you know, you're going to lose your plan, lose your doctor. There are lots of people who still believe that small business owners are going to be mandated to purchasing coverage for their employees, not true, not in the law.

But I would say the most disturbing piece, because this is such an American commitment, is all the misinformation around Medicare and what happens to somebody's benefits once you reach 65.

Medicare just celebrated a 45th birthday, and, you know, my dad was actually in the United States Congress when Medicare was passed in 1965 and helped negotiate that. Now, he's 89 years old and a pleased beneficiary with the program.

But I think seniors were particularly targeted with a lot of misinformation about the fact that, you know, something would happen to their guaranteed benefits, that Medicare Advantage plans would cease to exist, and people wouldn't have any options, that there'd be a restriction in coverage, that huge cuts were going to be made that would affect their care. Nothing could be further from the truth.

So we're doing a lot of outreach of, you know, providing information by mail, on the website, through 1-800-Medicare, which is a great ongoing resource, a huge call center. People can find out what's coming in the program, what's available, but to not only assure people that some of what they've heard is just not accurate, but actually that there are some great benefits: preventive care with no co-pay, closing the doughnut hole, and next year folks in the doughnut hole will have a 50 percent decrease in the cost of their brand-name drugs; a - annual checkup, which I hear about all the time. People say why hasn't this been a part of the plan? And it hasn't, but now it's going to be because keeping people healthy in the first place is much better than waiting until they're sick and paying a big hospital bill.

COX: You're listening to TALK OF THE NATION from NPR News.

Our time is just about up, and I want to thank you again for coming in and sharing...

Sec. SEBELIUS: Great to be here.

COX: ...some of your insights with us and with our listeners. There were many more calls and many more emails than we had the opportunity to get to, but in the 30 seconds or so that I have, Secretary Sebelius, we did not talk about mental health care. Is that part of the reform coverage?

Sec. SEBELIUS: Absolutely. It's part of the strategy. Congress, a couple of years ago, passed what's called mental health parity, so that health plans need to offer mental health benefits side by side with physical health benefits, not have a dividing line, not separate the care, the drugs, the treatment, and that will be very much part of the plan.

Again, healthcare.gov is a great website to go get information, to get personal questions answered, to put in - we're not selling anything. We're not collecting information. This is really to put some tools back in the hands of consumers, so you know what choices you can make.

COX: I can imagine that you must really be on a busy schedule talking to governors all over the country, trying to get them to listen.

Sec. SEBELIUS: Well, actually, governors I met with, again, a couple of weeks ago in Boston at the summer governors' meeting, and they're really working on implementation. The suits that have been filed by attorneys general sometimes are not even agreed to by the governors, but, you know, the lawyers will go off and talk in a courtroom. In the meantime, we want to make this work on behalf of the people who are eager. You know, parents can keep their kids on a policy up to age 26. I got to go, but healthcare.gov. Check it out, something good.

COX: We will invite you to come back in September when there will be more to talk about...

Sec. SEBELIUS: That's great.

COX: ...with regard to this. We appreciate it. Secretary Kathleen Sebelius, secretary of Health and Human Services, joining us here in Studio 3A.

Coming up, Gulf seafood and the smell test. The government says the fish is safe to eat. Many fishermen aren't so sure. We will talk with the head of a government testing program. Stay with us. I'm Tony Cox. It's TALK OF THE NATION from NPR News.

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