 I want to welcome everybody to New America. I'm Mark Schmidt. I'm the director of the political reform program here. And before I introduce Secretary Burwell, who's here to make some remarks about the future of health care on a number of dimensions in the new Congress and the year ahead, I just want to make a few quick comments about New America and why we're so honored that we're able to host her here today for these remarks. Among the founding principles of New America, which is reflected in the book, The Radical Center by Ted Halstead and Michael Lind, who are among the founders of this organization 15 years ago, was a commitment to get beyond traditional partisan alignments and specifically to apply that idea to health care, to treat it as a matter of both rights and responsibilities, and is something that should be vested in individuals and people, not just in some jobs and not others, and to improve care and not just coverage. Over the following years, the middle of the last decade, New America's health program, which is led by Laurie Rubiner, Len Nichols and Shannon Brownlee, worked to put that vision into place, particularly in the period 2006, 2008. This organization and Len Nichols created a space for bipartisan and, most importantly, cross-ideological conversation that ultimately, and it was wonderful to see it happen, ultimately resulted in some legislation that by 2008 had 10 cosponsors from each party and a piece of legislation that, in some ways, went further than the Affordable Care Act, but not in others. In my work on political reform, one of the things that we've done is try to look at the kind of situations where government can get things done, even in a situation where people have deep disagreements about values. And in doing that, I still look at the work New America did eight and 10 years ago. As a fascinating example, because it reaffirmed for me a very basic truth, that when people share a commitment to getting something done, when they agree that the status quo isn't good enough, and they're willing to talk to each other, then even if they're very deep differences about what to do and how to do it, but if people are willing to talk to each other, anything's possible, and people can find solutions even without giving up their core beliefs. And I think as Secretary Burwell will tell us, we're on the verge of an era where we can begin to have that kind of conversation again. I'm also looking forward to hearing Secretary Burwell's thoughts about innovation and how government can do better. Last week, two longstanding board members of New America, Lenny Mendenka of McKinsey and Laura Tyson of Berkeley published a wonderful article highlighting some of the ways in which the Affordable Care Act was encouraging innovation, reducing costs while expanding and improving care. They concluded the article 25 years from now, we hope that historians look back on the Affordable Care Act as the start of a new era of public-private collaboration to develop innovative solutions to complex social problems, and thus, to restore trust in government itself. We share that confidence. Now I want to introduce Secretary Burwell, when I was first, our staff said, you need Secretary Burwell's biography, and I said, you know, I actually really know Secretary Burwell's biography because, you know, when I was in government, she was a hotshot in government. When I worked in philanthropy later, she was a hotshot in philanthropy, but I'll do the full bio anyway. Sylvia M. Burwell was sworn in in June as the 22nd Secretary of Health and Human Services. That's a smaller club than I would have thought of people who have been Secretary of HHS. Before that, she served as director of the Office of Management and Budget, where she worked closely with Congress to restore order to the budget and appropriations processes. Before coming back to government and rejoining this administration, she was president of the Walmart Foundation in Bentonville, Arkansas during a period when that foundation surpassed $1 billion in total giving. For 10 years before that, she was president of the Global Development Program at the Bill and Melinda Gates Foundation in Seattle, Washington, which is an extremely large foundation, and works on a huge range of issues from vaccinations, children's health, agricultural development, and she was the foundation's first chief operating officer. During the Clinton administration, Secretary Burwell served as deputy director of OMB, deputy chief of staff to the president, chief of staff to the secretary of the treasury, and staff director of the National Economic Council. She was born and raised in West Virginia, received her A.B. from Harvard, and a degree from Oxford. So we're pleased to have her here. Let me just do a quick logistical thing. After her remarks, we'll have questions and answers. You have cards for questions. Please put your question on it and your name. We'll go through it and I'll call on people and you'll say your question, but we want to do it efficiently with the cards first. So with all that, Secretary Burwell, we're pleased to have you. Thank you very much, Mark. Appreciate it. And it's great to be here at the New America Foundation. Mark Twain once said that you can't depend on your eyes when your imagination is out of focus. And I think the great thing about the New America Foundation is that you work to refocus our collective imagination on the things that we can do together to renew American prosperity. And that's a very important thing and why I think this is the ideal place for me to be, to reflect upon the values and interests and priorities that we have in common as Americans and in the broader sense as citizens of a shrinking planet. I've long believed that across the globe, regardless of your nationality or your financial status, that we all basically have the same desires for our children. And that is, we want them to live healthy and productive lives. And as the mother of a seven and five year old, I share that dream as well. I'm a believer in the notion that people who share common interests and common dreams ought to be able to find common ground. And that's what I wanna talk with you about today. I truly believe that there are a number of things where we have an opportunity and in fact, a responsibility to get done together in this new year, working across the aisle and working across different sectors. This is especially true in healthcare, where our system is on the threshold of both positive and I believe transformational change. There are also opportunities that flow from the innovations in science and medicine that are being advanced by American scientists, researchers, and entrepreneurs. Many of these innovations are redefining the boundaries of progress. At the same time, they're opening the promise of a new innovation economy. The opportunities before us are good for families, they're good for business, they're good for the economy, they're good for taxpayers. There are things we can get done if we work together. And I believe there's a shared interest on both sides of the aisle and with business and civil society communities in moving them forward. At the same time, the new year did bring in a new round of efforts to repeal the Affordable Care Act. These efforts are happening despite increasing evidence that the law is working. Millions more Americans have access to quality affordable care, some for the first time. What's more, millions of Americans who are already insured are benefiting from the law as well. As you can imagine, I will be vigorous in making the case that this law is working and that families, businesses, and taxpayers are better off as a result. I believe this firmly, and as I've traveled around the country, I've been told by people that I've met that they're not really concerned about the next headline. What they're concerned about is the next generation. They want us to stop the back and forth to move forward and to focus on the substance. And that's really what I wanna talk about today. I count myself among those who do not believe that disagreements in some areas, even significant disagreements, should prevent us from moving forward on others. Medicaid expansion is an example. Governors from 27 states plus DC, including those who disagree on elements of the Affordable Care Act, have reached the same conclusion. Expansion is good for the people and the economies of their states and some who have not yet expanded have expressed interest in moving forward. States like Wyoming, Indiana, and Utah. I wanna see all 50 states expand in ways that work for their states and we will work with governors from both parties to try and make that happen. There are other critical areas in healthcare where our common interests give us ample opportunities for common good. Improving the quality of care we receive while spending our dollars more wisely. Reducing substance use disorders and overdose deaths. Strengthening global health security. Reaffirming American leadership in research, innovation, and science, and building an innovation economy. Let's start with our healthcare system. For all the differences of opinion about how to move forward, there is one area which we have unanimous agreement and that's that the system that's been in place for 50 years has under delivered on access, affordability, and quality. You could almost sum it up with the prices we paid, far outweighed the progress that we made. Health costs grew significantly faster than things like GDP and middle class family incomes. We all felt the effects of a system that did not spend our healthcare dollars as wisely as we could have. However, over the last several years, we started making significant progress, thanks in large part to the Affordable Care Act. It's now within our common interest to build a healthcare delivery system that's better, smarter, and healthier. A system that delivers better care. A system that spends healthcare dollars more wisely. A system that keeps us healthy rather than waiting for care when we get sick. A system where medical information and medical bills are easy to understand. A system that puts information in the hands of patients and doctors and empowers them to make better choices. If we do this, we will leave a legacy for our children and our grandchildren. And as I've met with members of Congress from both parties, they've told me they want a better system too. They want to tackle healthcare-associated infections and patient harms. So we keep patients safer when they're in the hospital and healthier when they're out of it. We are already making progress as a country. We've achieved a 17% reduction in harms nationwide since 2010, and members of Congress from both parties also share our interest in payment innovation. We all want to find better ways to reward quality and high-value care in the system. There are opportunities to work together on putting better information in the hands of patients and their doctors and building a more transparent system. We've had fruitful discussions with Congress about supporting and encouraging the interoperability of information in our healthcare system. We also share members' interests in expanding access to Medicare claims and clinical data to support innovation and empower consumers with information. Medicare and Medicaid are two of the largest health insurance plans in the world. Together, they cover one in three Americans. So one of the things we're going to do is leverage the grant and rule-making opportunities to improve the quality of care that beneficiaries receive while spending those dollars more wisely. We understand that's our role and it's our responsibility to lead and we will. But what we won't do and can't do is go it alone. Patients, physicians, government, business, we all have a stake and I believe that this shared purpose calls out for deeper partnerships. Some of our most important results-driven partners are actually state governments, which are taking creative and innovative steps when it comes to improving the quality and achieving smarter spending of Medicaid dollars. I believe we have an opportunity to strengthen our relationship when it comes to things like modernizing Medicaid enrollment systems, improving models for care in payment, coordinating and improving the care that's delivered to beneficiaries in managed care. Part of building a healthcare system that keeps us healthy is actually reducing substance use disorders and overdose deaths. For millions of Americans who rely on prescription painkillers known as opioids that are prescribed to them by their doctors, these drugs can be the difference between constant chronic pain or welcome relief. However, these drugs can be deadly. In 2009, drug overdoses overtook every other cause of injury death in the United States, outnumbering fatalities from car crashes for the first time. Meanwhile, in 2012 alone, 259 million opioid prescriptions were written. That's enough for every American adult to have a bottle. rural America, including my home state of West Virginia, knows the tragedy of this issue all too well. Moving forward, we hope to work with members of Congress from both parties on the goals we share for driving down opioid dependency and overdose deaths. This is a critical and complex public health challenge and requires a multifaceted approach. We have an opportunity to work together on improving opioid prescribing practices by enhancing prescription monitoring, data sharing, and clinical decision making. We also want to incentivize the development of abuse deterrent opioids and expand the utilization of noloxone, a drug that used to reverse is used to reverse overdoses. And there's more we can do together in the realm of medication assisted treatment to help those who are addicted break that cycle. Last session, Congress introduced more than a dozen pieces of bipartisan legislation to try and address this problem. Many proposing ideas that would help fuel progress in some or even all three of these areas. And we think we should continue to work together. I want to turn for a moment to global health security. The tragic Ebola outbreak is a solemn reminder of our common humanitarian and security interests. The most effective way to protect Americans here at home from outbreaks and other public health threats abroad is to stop diseases and their threats of them at their source. Microbes and diseases are moving faster and further than ever before in human history. And they do not recognize national borders. I want to take this opportunity to thank the Congress for choosing to act and invest in this critically important common ground priority of global health security. Recently, in a bipartisan fashion, members of both parties made a $597 million investment with the CDC to advance the global health security agenda. And it's three pillars of prevention, detection, and response. We want to work with our global partners to enhance their prevention strategies and tools for both naturally occurring and man-made threats. With only about 30% of countries reporting that they actually adequately can detect, respond, or prevent the health threats proposed by emerging diseases, there is an urgent need for this sort of investment and commitment. And it's important to note that just as Congress has stepped up to the plate, so have governments from other countries who are choosing to invest as well because they recognize that all of us have a stake in stopping outbreaks before they become pandemics. In September, President Obama convened the 44 countries that have signed on to be a part of that agenda, covering 4.8 billion people across the world. These countries have the will and the desire to implement the global health security agenda, but many of them require assistance to achieve the full range of its goals. This is an important start from both a national security standpoint and a humanitarian one. Our goal must continue to be for every nation on earth to have the ability to prevent, detect, and respond to infectious disease threats. Our Ebola efforts overseas and our preparedness efforts here at home have also shown us where we can improve our abilities to add capacity and flexibility and wisely deploy resources in times of public health emergencies. We hope to work with the Congress in the spirit of the emergency funding we received, and that includes making sure that we share our approach for spending of this funding. I want to now turn to another area where we as Americans both have an opportunity and responsibility to lead innovation, in science, and medicine. The investments we've made through our federal government have reshaped our understanding of health and disease, advanced life-saving vaccines, and helped millions of our fellow citizens live longer, healthier lives. But there's more we can do and should do together. And while we can always do better, our goals are bolstered by the FDA's speedy regulatory review process. In the United States, our process is not only one of the most efficient in the world, but our drug review times are consistently faster than other advanced authorities around the world while maintaining the highest safety standards. In the last year alone, FDA approved the most new drugs in almost 20 years, including more drugs for rare diseases and more new therapeutic biological products than ever before. We want to work with the Congress to secure the investments in science, research, and innovation that will allow our nation's scientists and researchers to continue the progress they've been making on new and improved vaccines, cures, therapies, and rapid diagnostics. A few months back, when Republican Representative Fred Upton and Democratic Representative Diana DeGette invited me to attend a panel on 21st century cures, I said, where and when. Because I firmly believe that we have many common ground opportunities to work together. And I look forward to working with Chairman Upton, Ranking Member Palone, and Representative DeGette on this bipartisan effort. As we look to move forward, I've told members of Congress from both parties that we agree with them on the need to improve innovation, collaboration, and data sharing among scientists, to respond to patients' needs and give them a meaningful voice in their own care, to bridge scientific gaps and bring products to market, to attract the best experts to accelerate cures, to reduce the administrative burdens and duplication, and to do all of this while maintaining and protecting the public's health safety. I wanna give you an example of how, by moving innovation forward, we have the opportunity to deliver the sort of impact that can touch the lives of so many for the better. And that example is precision medicine. The science of harnessing our understanding of the human genome, to customize our medical care to our own personal genetic makeup. For most of history, medical practitioners have been forced to make recommendations about prevention and treatment based largely on the expected response of an average patient. The ability to assess and use information about important differences among individuals has been very limited. The promised precision medicine has is that it gives us the ability to develop medical treatments that are highly tailored to the individual characteristics of patients. I hope we can work with the Congress to scale up the initial successes we have seen in this promising avenue of scientific endeavor. It's in the interest of our health and our children's future to make these breakthroughs happen. It's in our economic interest to make sure that they happen here. I wanna close by the way I opened and that's by talking about the common dreams that we share for our children. If we take action to advance innovation and if we choose to work together on the other priorities I've outlined this morning, then I believe we will build a stronger, healthier future for the next generation. In doing so, we can create a 21st century innovation economy in which we lead the world in advancing the next generation of scientific and medical innovations. At the same time, we help American entrepreneurs capitalize these innovations into the market for economic growth. The 21st century has been called the century of biology. And in this bio century, our common interests in job creation and innovation are mutually reinforcing. Steve Jobs told his biographer Walter Isaacson that he saw parallels between the ways medical research was capturing his son's imagination and the ways in which computers and captured his own. Jobs said, I think the biggest innovations of the 21st century will be at the intersection of biology and technology. A new era is beginning, just like the digital one when I was his age. This intersection presents us with some of the most fertile ground for building an innovation economy. As President Obama said, what America does better than anyone else is spark the creativity and imagination of its people. We know that when we give American innovators the opportunity to innovate, they accomplish big things. This is especially true when it comes to innovations in medicine. I'm looking forward to working with leaders from both parties, from the private sector, from civil society, and from the scientific and medical communities to deliver impact and drive progress that is worthy of the possibilities of our time. As I mentioned up front, I hope that we can move beyond the back and forth of the Affordable Care Act and focus on the substance of access to affordability and quality. Working families have come to count on that financial security that comes with having quality, affordable health coverage. As Secretary, I am contractually obligated to mention that open enrollment goes until February 15th. Whether we're talking about affordable health coverage, a better, smarter health system, a healthier population, or a more secure world, I think it's fair to say that as a country and as a world, we are on the threshold of positive and transformational change. It's up to us to build the common ground necessary to reach our common dreams. The world is watching. The next generation is waiting. The work is up to us. Thank you very much. I think we will take some questions. We will take some questions. First question is David Morgan from Reuters. Is David here? Oh, go ahead and ask your question. Hi, I wanted to ask how confident you are given that two thirds of the open enrollment period has passed that enrollment will in fact meet or exceed your target of 9.1 million enrollees. I believe that we've made strong progress. You probably saw the numbers that we announced yesterday for the federal marketplace that we're almost at 6.8 million people who have either re-enrolled or have newly enrolled. And as I've said all along and said before we even started this open enrollment, it's my job to keep us focused every day. We have a ways to go. It's a short period of time to reach the 9.1 million and that's an infexuated number of the goal that we set out. So every day we are working hard against that. You probably know and saw that yesterday this is a week of Latino action firmly focused on that group and we're gonna continue to focus across the populations that we're trying to reach. I'm out there traveling quite a bit to different places and what we're trying to do most to try and get to that goal is meet the consumer where they are and that's both in terms of the speed and ease with which they can sign up and getting them the information they need to get there. Great, thank you. Mary Agnes Carey, Kaiser Health News. I know you meet with a lot of members of Congress. I'm wondering what you're hearing from Republicans, especially in the Senate, about possible common ground around the Affordable Care Act. So much of the conversation as is reflected in this speech is as I focus on the issues where I think there are places for common ground. And we know that the issues that I mentioned, the bipartisan bills, there have been bills on the issues of opioids that have been proposed by Senator Porter. Senator Ayotte has been an important co-sponsor of that legislation. Senator Wyden has been involved and engaged. On the House side, Mr. Rogers, who is from neighboring Kentucky, West Virginia, deeply interested in those issues. The issues, and that whole list of issues that I've mentioned, those are much about what the conversation's about. One of the things that I'm trying to do and this speech is a reflection is, focus on the places where we have common ground. And there are, as I outlined today, whether that's delivery system reform where people do want to improve the effectiveness and efficiency of the dollars at the same time we do the quality. So that's the place where I focus mainly. Around with Republicans on the HCA, I mean, that is a key law. They are fighting it, but are there members that maybe have a different message or a different agenda than their leadership has? We are hopeful and look forward to that opportunity. As we've said all along, we want to find the places where the act can be improved. And we did support the hero's piece of legislation that came before us, and as I've said, we think about it in terms of affordability, access quality, and how things affect the economy. That's how we think about it. We welcome the conversation. We look forward to it. At the same time, we want to work to make progress on issues where we know that there is clearly common ground that we've seen. Joe Minnard from CED. What do you see as the next steps, particularly in the direction of affordable care, either through legislation on a bipartisan basis or from non-legislative action? So I think as we think about the Affordable Care Act and continuing to move forward on the issues of affordability, quality, and access, I think making sure that we have a successful open enrollment and that we continue to serve the consumer, that's the thing that is most in front of us right now. That's both about quality and affordability. Second, and continuing to work on that in the marketplace and contributing to a marketplace that works for consumers. Second, in terms of continuing to work on that space, I touched upon it in these remarks, Medicaid expansion is an important place for focus, and that's a place that has more to do, perhaps with governors, but in a bipartisan fashion because of the states that are left and have communicated clearly. We wanna work to do plans that work with states. In my conversations, it's reflected that different governors have different priorities for their people and their states. We wanna work with them with flexibility. There are certain key elements of the expansion that were legislated and that we believe are important from a policy perspective, but we're open to the innovation of states. So that's area two. Area three, Joe, in terms of the areas of focus on those three things and moving that ball forward is to continue the work on delivery system reform. And that comes in a number of different ways, and that's one where it's going to take the government executive branch and the rulemaking and grantmaking that I mentioned as a place that's very important to drive how payment reforms can occur because we are such a large payer. It has to do with what the private sector is doing. And so that's the next one. And then the last one is focusing on how we make sure that this access translates to care for individuals. So whether it's in those that are newly insured or those of us who had employer-based coverage and that there are additional benefits and whether that's the preventative care that you can be doing or the flu shot that you could be getting without copays or the child wellness visit. And so that fourth area of focus, Joe, in terms of moving those balls forward is about focusing on making sure that it isn't just the access, it is the question of the actual use and the benefit that comes from it. I wanted to take the moderator's prerogative and just ask you a quick question. Yes. Crossing over your experience at OMB and NHS, do you foresee a future in which the kind of things you've proposed today, some of the things that are beginning to happen with the ACA begin to reduce the growth of healthcare costs in a way that begin to take some of the pressure, maybe change the complexion of the debate about the long-term federal fiscal situation and potentially create new opportunities for different coalitions and alignments around that set of issues? So I think we have seen since I arrived in town at OMB in terms of the deficit reduction, the most recent deficit numbers, overcut in half from the point in which I arrived. And so we continue to see downward pressure, I think always as an OMB director, it's important that we always keep our eye on the long term, which is one of the issues that people have their eye on and healthcare costs are an important part of that. What we have seen is the changes in terms of, when you start to see that 2011, 2012, 2013, those numbers in terms of the lowest per capita healthcare cost growth that we've seen on record, when you see that downward pressure on Medicare in terms of its per capita growth being nearly flat over an extended period of time, I think we're starting to see that. Now, the question of are those structural changes that will last for an extended period of time, how that incorporates with more people getting care, we need to keep our eye on. And that's why I was emphasizing so much delivery system reform. Because while that's an issue that's about quality, it is about changing the way we do things so we get some of that long-term cost savings that we're talking about. Ricardo Alonso is out alive. Hi, thank you for taking my question. And in your speech, you didn't mention SGR and CHIP. And could we get what your outlook is for those two programs and what has to happen on the Hill this year? And does the fact that you didn't mention these two programs mean that you think it's gonna be contentious? So glad you raised them. Probably the reason that I didn't mention is because if this speech lasted much longer, I'm not sure how long all of you would be here. The issue, I think those are both important issues and I actually think they do fit into the frame of the conversation and what this speech was about, which is general bipartisan support, both for SGR as well as the issue of CHIP. And so I think those fall into the category of things where I think there will be bipartisan support. I think those are very clearly legislative issues that the Congress will take the lead in terms of the timetable and focus that they will do, but not mentioned because I thought that they were very contentious. As a matter of fact, if I'm on the ledger of putting things in columns of more contentious or greater possibility for working together, I see both of those in that category of greater possibility for working together. I think the question will come back to a point that was just raised in terms of deficits and that sort of thing as one looks at costs. The administration has expressed support for both of them and so the question is a legislative approach to achieve them. Well, we want to thank you all for coming and we especially want to thank Secretary Burwell for joining us at New America and we hope you'll come to future events here. Not always as high profile as this one, but we're really glad we could host you all today. Thank you very much. Thank you. Thank you.