Kathleen Sebelius, U.S. Secretary of Health and Human Services | The Forum at HSPH
U.S. Secretary of Health and Human Services Kathleen Sebelius Answers Your Questions About Health Care
Everyday Health readers submitted questions that we asked U.S. Health and Human Services Secretary Kathleen Sebelius. Here's what Sebelius has to say about health care under a second Obama administration, the Affordable Care Act, childhood obesity, breast cancer, and more.
By Everyday Health Staff
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Everyday Health: What are the Obama administration's long-term plans to lower the cost of health care?
Secretary Sebelius:The health care law, the Affordable Care Act, helps lower costs in several ways. First, we’re focusing on prevention, and fighting disease and illness before they happen. Chronic diseases – such as heart disease, cancer, stroke, and diabetes – account for 75 percent of the nation’s health spending. Now, because of the law, preventive services, including cancer screenings and vaccinations, are available for many Americans with no out-of-pocket costs like co-pays or deductibles. Focusing on prevention can both improve the health of Americans and help control health care spending.
Also, we’ve put in place new rules to make sure you get your money’s worth when it comes to health care. The health care law generally requires insurance companies to spend at least 80 percent of consumers’ premium dollars on health care — or provide rebates to their customers. As a result, nearly 13 million Americans have received more than .1 billion in rebates this yearalone. And for the first time ever, new rate review rules prevent insurance companies in all states from raising rates with no accountability or transparency. To date, rate review has helped save an estimated billion for Americans.
Looking ahead to 2014, individuals and small businesses will have access to new competitive private health insurance marketplaces called Exchanges. These will provide people with a “one-stop shop” to find and compare health insurance options based on price and quality. By increasing competition among insurance companies and allowing individuals and small businesses to band together to purchase insurance, Exchanges will help lower costs. And under the law, Americans with low incomes will be eligible for tax credits to make sure they can afford coverage.
EH: Can you provide a picture of what U.S. health care might look like under President Obama’s second term?
Secretary Sebelius:Prior to the law, an insurance company could refuse to sell a policy or charge a person more just because the individual had a pre-existing condition, anything ranging from acne to cancer. In 2014, it will be illegal for insurance companies to discriminate against anyone with a pre-existing condition. In addition, families will be free from the worry of having their insurance cancelled or capped when a family member gets sick, or going broke because of the medical costs of an accident or disease.
And those with Medicare can get many preventive services free of charge, save on their prescription drug costs, and know that Medicare is stronger overall. In 2014, through Affordable Insurance Exchanges, individuals and small businesses will be able to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program, and enroll in a health plan that meets their needs.
EH: Is the Affordable Care Act really affordable? Do the advantages of the law outweigh the costs?
Secretary Sebelius:Yes. Prior to the passing of the law in 2010, it was all too common to hearstories of families going bankrupt as a result of medical bills, or seniors who skipped medications because their prescription drug costs were too high to keep up with. One of the major reasons we passed the Affordable Care Act was to bring down costs.
The law makes health plans more affordable for small businesses and individuals by creating a marketplace of state-based Affordable Insurance Exchanges. Health plans with similar benefits will be compared on an “apples to apples” basis, creating a new level of competition that drives down costs even further. Tax credits will be available for many individuals, families and businesses to help them purchase coverage in the Exchanges. And the law emphasizes prevention because we know it is far less expensive to prevent disease than to treat it. Under the Affordable Care Act, many preventive services are available without cost-sharing to help patients avoid chronic conditions and the painful and costly complications that go along with them.
EH: In the next year, what changes will Americans see to the U.S. health care system? How will health care access change for the elderly, children, and women?
Secretary Sebelius: First, if you're self-employed, between jobs, or can't get insurance through work, you'll have access to affordable health insurance in 2014 through new competitive insurance marketplaces know as Affordable Insurance Exchanges.
For the elderly, Medicare is now stronger than ever. Thanks to the health care law,Medicare prescription drug coverage is now more affordable as we work to close the prescription drug gap known as the “donut hole.” Already seniors are receiving many preventive services, like flu shots and an annual wellness exam, with no co-pay or deductible.
Millions of women are now getting preventive services like cancer screenings, flu shots, and blood pressure tests, with no co-pay or deductible. Starting in 2014, it will be illegal to deny someone coverage because they’re a breast cancer survivor or pregnant, as insurance companies have done in the past. And it will also be illegal to charge women more than men just because they’re women.
And for children, already health plans that cover children can no longer exclude, limit or deny coverage to your child under age 19 based on a pre-existing condition. Additionally for children, the law requires new health plans to cover recommended preventiveservices, including vaccinations, well-baby visits and well-child visits, cost-free. And because of the law, most young adults can stay on their parents’ plans until age 26, giving them the freedom to make choices based on what they want to do, not on where they can get health insurance.
EH: Schools are no longer required by the government to include physical education in their curriculum, but studies have shown that children who get regular exercise are healthier and perform better academically. Might these requirements change in the future?
Secretary Sebelius:Decisions regarding physical education curriculum requirements are made by local schools, communities and states. I am pleased to report that many initiatives are taking place on the local level to encourage school children to exercise more. Through public-private partnerships, safe routes to walk to school and places to play are being made available in neighborhoods across the country. Everyone has a role to play – parents and caregivers, school teachers and administrators, community leaders, local elected officials, after-school programmers, and health care providers.
EH: Obesity and related chronic diseases continue to be a problem for this country. What more can HHS do — or is it thinking about doing — to promote healthy lifestyles?
Secretary Sebelius:This past February, First Lady Michelle Obama celebrated the two-year anniversary of theLet’s Move!initiative. The goal ofLet’s Move!is to solve the problem of childhood obesity within a generation so that children born today will reach adulthood at a healthy weight. HHS is working withLet’s Move!to combine comprehensive strategies with common sense to put children on the path to a healthy future during their earliest months and years, give parents helpful information and foster environments that support healthy choices, provide healthier foods in our schools, ensure that every family has access to healthy, affordable food, and help children become more physically active.
The U.S. Surgeon General led an effort by 17 Federal Departments to develop the United States’ first-ever National Prevention Strategy. The goal is to increase the number of Americans who are healthy at all ages by identifying evidenced-based recommendations to prevent chronic disease and promote wellness.
HHS also issues science-based advice to promote health and reduce obesity and risk for major chronic diseases. Together, theDietary Guidelines for Americans, 2010, released by HHS and USDA, and the2008 Physical Activity Guidelines for Americansprovide guidance on the importance of being physically active and selecting nutritious foods for living a long and healthy life.
Last month, HHS, with the help of the President’s Council on Fitness, Sports and Nutrition, launched its Physical Activity Awareness Initiative to educate parents and caregivers about the physical and cognitive benefits of daily activity among youth.
EH: The recommendation from the U.S. Preventive Services Task Force that most women under 50 don't need annual mammograms continues to be controversial. What is HHS doing to promote this recommendation, and what guidance is it offering concerning breast self-exams?
Secretary Sebelius:Mammograms are an important life-saving tool in the fight against breast cancer. Women should keep doing what they have been doing for years—talk to their doctors about their individual histories, ask questions and make the decision that is right for them. Under the Affordable Care Act, women older than 40 may get annual mammograms with no copays or deductibles. Health insurance must also cover other services for certain women at increased risk, including a referral to genetic counseling and a discussion of chemoprevention. For women in new private plans or renewing plans, the health care law covers a well-woman visit, during which women may discuss their health needs with their physicians.
Regarding breast self-exams, the self-exam cannot replace regular screening mammograms, conducted by a health care provider, to detect breast cancer early.
EH: There is so much research being done on breast cancer, but is anyone looking into the consumption of things like everyday foods and cleaning products as breast cancer risk factors?
Secretary Sebelius:Researchers are looking into a number of risk factors. What we do know are the factors that increase a woman's risk of breast cancer – including older age, certain genetic mutations, family history of breast cancer, personal history of breast cancer, and daily alcohol consumption. Factors that may decrease a woman's risk of breast cancer include breast-feeding and exercise. Visit the National Cancer Institute for more information about cancer risk factors.
Video: Remarks on Medicare drug pricing proposals by Health and Human Services Secretary Alex Azar
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