Eli Adashi, MD: Hello. I am Eli Adashi, Professor of Medical Science at Brown University and host of Medscape One-on-One. Joining me today is the honorable Kathleen Sebelius, Secretary of Health and Human Services. Our topic is the implementation of the Affordable Care Act, now at the 6-month mark. Welcome, Madam Secretary.
Kathleen Sebelius, MPA: Thank you. Good to meet you.
Dr. Adashi: It is wonderful to have you.
Ms. Sebelius: Thanks.
Dr. Adashi: I seem to recall you sitting in the Senate gallery during a key vote during the great healthcare debate. You obviously sensed history in the making, or else you wouldn't be there. How do you think of it today, 6 months later?
Ms. Sebelius: I still think we have seen the President sign into law what may be the most significant healthcare bill in the history of our country, certainly in the last 45 years since Medicare was passed. We have had a front row seat here at the department in putting the pieces in place that are beginning to show real benefits to people, and it has been a very exciting time.
Dr. Adashi: Are you at all concerned about the background discussions about repeal or some other ways of constraining what was such a mammoth effort?
Ms. Sebelius: Well, of course, I am concerned. I think that the more Americans understand what the law actually does and doesn't do, and once they begin to feel the benefits for themselves and their families -- We heard from a lot of parents, for instance, who had children graduating from great schools like Brown, who now can keep those young adults on a family plan. They were thrilled. Parents, at the 6-month anniversary, will be able to have children with pre-existing conditions, some for the first time ever, have health insurance that they can count on. Seniors are beginning to see some help with prescription drug costs. So as people figure out what this does for them, we're seeing people being more enthusiastic about the program.
Dr. Adashi: I think you're referring to a whole series of patient rates, in a sense, that are going to kick in come September 23. What element of the act do you consider the hardest to implement? What keeps you awake at night?
Ms. Sebelius: There are some pretty daunting time tables in the bill. And, actually, as the discussions in the House and the Senate slip from 2009 into 2010, none of those time tables were changed, so we have been working tirelessly to make sure that the regulations were written in a timely fashion and that the benefits that people are looking forward to actually come into the marketplace. So this 6-month anniversary is an important date, and what I'm pleased to say is that companies are prepared to implement the changes. I think people will be seeing some new benefits. And also, we have this great new Website, Dr. Adashi. I don't know if you've had a chance to use it.
Dr. Adashi: All the time, yes -- Healthcare.gov.
Ms. Sebelius: Healthcare.gov. Absolutely. Up and running with some tools for consumers. I mean, you could find more information out about a toaster that you wanted to buy than about health insurance that might be available to you in the past.
Dr. Adashi: Absolutely.
Ms. Sebelius: I'm a big believer that informing consumers is a big way to get some more power into people's hands.
Dr. Adashi: My wife is certainly a fan. She has a mother who needs individual health insurance, and she is already checking it out.
Ms. Sebelius: Well, good. And tell her that in October, there will be pricing information added to the plan information, so again, a big step forward.
Dr. Adashi: Thank you. With about 32 million patients joining the insured ranks, will the Act be expanding the medical provider workforce, which is a concern out there?
Ms. Sebelius: Sure, and it's a concern whether or not we pass the Affordable Care Act. We need more doctors. We need particularly more primary care physicians in underserved areas. I just came from an announcement of an additional $130 million in workforce grants, some Recovery Act money, some Affordable Care Act money, that will begin to populate the pipeline. The President has been very focused on workforce, and so we're doubling the size of the National Health Service Corps, which is our --
Dr. Adashi: The community health centers.
Ms. Sebelius: Well, it's [about] community health centers, but it's [also about] a variety of practitioners. We pay off their medical loans in exchange for a couple of years of service in an underserved area. And that has been a very effective strategy, but we'll have to double the number. We are putting more money into nurse and nurse practitioner training and into mental health technologists, and we are beginning to change the payment rate for primary care docs, so more medical students can see it as a viable option going forward. So, more force is definitely a part of the plan, and we'll have at least 16,000 new primary care providers in the next several years. I think that's very good news.
Dr. Adashi: What other ways, since we are discussing primary care, will the new act facilitate the practice of primary care in general?
Ms. Sebelius: Well, there are a couple of pieces of the puzzle. If you think about what we have now, I like to call it a "sickness system," not a very good health system, because there's a lot of time, attention, and money spent once someone gets ill in treating that illness but not very much focus or attention on preventing that illness in the first place. So, there are new investments in preventive care, not only consumer benefits, so insurance companies will begin to cover screenings for cancer and immunizations for kids, and a whole variety of preventive care without co-pays or co-insurance. But also, we're focusing on some community efforts to reduce smoking, to reduce the rates of obesity, both of which are big underlying causes of a lot of chronic illnesses.
The introduction of electronic medical records allows a primary care doc, I think, to very effectively to coordinate care of his or her patients. No longer will the specialist not be able to talk to the doctor and coordinate the medicine with the pharmacy, but [the electronic records will tie] that information together and allow a patient to do one-stop shopping, have a snapshot of what's going on, and have doctors and hospitals and nursing homes work much more closely together, but around the primary care model. There is a new effort on a medical home, again, around the notion that having a health home, making sure people have regular checkups, and have a medical provider that again, is a strategy -- not to wait until somebody comes into an emergency room and gets checked into the hospital, but to keep them healthier. So not only are more docs paid at the primary care level, but some other strategies I think will reorient our healthcare system to primary care and preventive care.
Dr. Adashi: So, a real array of initiatives that hopefully complement each other to produce some improvement.
Ms. Sebelius: Well, just a snapshot right now.
Dr. Adashi: Please.
Ms. Sebelius: We spend, in America, about 75 cents out of every healthcare dollar in treating chronic conditions -- diabetes and heart disease and other issues which we know, if we spent some time and energy at the front end, we might be able to prevent. So it's not only good for the overall budget, but it's going to save lives, I think, and lead to a more productive workforce. We currently spend a lot of money, but we don't really have health conditions in Americans that look very good.
Dr. Adashi: On this note, our sincere thanks to Secretary Sebelius, and to you, our viewers, for joining Medscape One-on-One. Until next time, I am Eli Adashi.