 Well, good evening everybody. I am delighted to have a chance to visit you a bit in San Antonio. I have to thank Dr. Slanker for that very kind introduction and tell you I feel right at home. I went to a Trinity University. Mine was in Washington, D.C. but it feels like I'm home in college and I said I have a particular fondness for San Antonio because not only do you have a great city but when I was governor my beloved Kansas Jayhawks won the national championship here in San Antonio so it will always be a warm place in my heart and certainly it's a warm place in everybody's heart today. I've spent today in Texas, started this morning in Austin with a series of meetings and then here in San Antonio and just came from a great meeting organized by Mayor Castro. We had the congressman there, several members of the legislature, Dr. Slanker and others from the city and county health departments, stakeholders and outreach groups and what I can tell you is that while there may not be a lot of engagement with state officials, there is a lot of enthusiasm and engagement with local and regional and county officials throughout the state of Texas. I see it every day. It's very enthusiastic and I think that's the kind of outreach that will really make a huge difference. I appreciate all of you being here tonight. I know you're going to have a chance not only to hear a little bit from me, but also to talk to folks later on the panel who can answer questions and tell you about what is going to happen over the next couple of months. There's no question that cities across the country, including here in San Antonio, face some tough challenges. The need to keep the local economy thriving, to ensure that streets are kept safe, to promote job growth and strengthen schools to create a more competitive workforce. All of that has to be done on a tight and sometimes tighter budget, restricting budgets. There's a common thread, I think, connecting all of the biggest challenges that San Antonio and other cities face across the country. That common thread is really health, health of our citizens. Health is really an underlying feature of everything that happens in cities and towns and communities. Healthier communities lead to healthier students and more productive workers. Companies now more and more look at cities health profiles before deciding where to locate a new site or open a new branch. Now here in San Antonio, tremendous progress is being made on health. Just last week, we heard that the obesity rate in Bear County dropped by about 20% between 2010 and 2012. That's a really important step forward, because obesity is one of the issues that underlies a lot of chronic health conditions, and that can mean a real step forward. But despite that progress, what we also know is that too many cities have continuing high obesity rates, have way too many smokers, have chronic disease rates. We have way too many people not only here in Texas, but across the country living too sick and dying too soon. And cities often are squeezed by the burden of those high health care costs. When costs are high and care is unaffordable, the consequences fall on the cities. So no matter what the top priorities are of city leaders for building the San Antonio economy and the San Antonio future, each of you, whether you know it or not, has an interest in fostering a health care system that contains costs and improves health. And those are exactly the goals nationally that cause the passage of the Affordable Care Act. So what has happened in the last three and a half years since President Obama signed the law? What we know is a lot of people with private insurance coverage are already seeing benefits from the health care law. And that's about 77% of Texans who currently enjoy private coverage. We know that there are hundreds of thousands of young Texans under the age of 26 who now are covered on their parents' plan, insurance that they did not have before 2010. And they have a lot more freedom to actually pursue their own dreams or take a job of their choice since they have affordable coverage. More than five million Texans who have private insurance are now receiving, as part of their insurance plan, preventive care with no out-of-pocket costs. And there's a real strategy behind that, to take down the financial barriers for preventive care, everything from cancer screenings to immunizations, knowing that it's better to keep people healthy in the first place, have situations identified early than treat diseases and illnesses later when they've had a chance to thrive. So people are not any longer putting off potentially life-saving cancer screenings and mammograms because they're worried about the costs. Last year alone, about 200,000 Texas seniors on Medicare saved an average of $680 on their prescription drugs. The Texans who fell into the so-called donut hole, the gap in prescription drug covers, that's real money in people's pockets. And they've saved that each year that the donut hole has been closing. That's all a part of the Affordable Care Act. So the last feature of implementation is about to start. And this really is for the 23% of Texans who do not have affordable coverage in their workplace or are not part of Medicare or are not a veteran and have veterans benefits. It's for people who have been purchasing coverage on their own, small business owners who are in and out of the market. They are looking forward to a new opportunity. So in every state in the country, regardless of what you hear, in every state in the country, there will be a new health marketplace open for business on October 1st. There will be online availability that now is up and running, a website healthcare.gov that's available in Spanish and English, healthcare.gov or quidado de salud.gov is running right now and begins to give people information about what is going to be available on October 1st. What kinds of plans they'll have a chance to choose from and what kinds of coverage may be available. Every new plan in the marketplace has to cover a set of essential benefits, including doctor visits, prescription, mental health services. There will no longer be any discrimination allowed based on gender. Being a woman will no longer be a pre-existing condition and that's very good news for a lot of women who are in the marketplace right now being charged a lot more than their male colleagues or friends and you won't any longer be locked out with a pre-existing health condition like diabetes or cancer. As many as 90% of Texas buying coverage in the new market we think will qualify for significant breaks on their monthly premiums based on their income levels. So for instance for a healthy 21-year-old man earning $17,000 a year here in San Antonio, a plan today might cost him about $111 a month. Next year he'll be able to get that coverage or better coverage for about $55 a month. A healthy 30-year-old woman earning the same amount who may be paying $183 a month because women can now be charged up to 50% more than men will be able to get the more generous plan again for $55. A 60-year-old man who earns $45,000 a year who might pay a monthly premium of over $500 a year will be able to get that same plan for about $350. So what we're seeing develop in the markets we have about 11 states where the market rates are now very clear and in other states like Texas where they're still being finalized but in the states where the market rates are available right now they're running about 18% under what the rates are right now in the market for an identical plan and that doesn't include the opportunity to get an additional subsidy to help pay for that premium. So thanks to the marketplace insurance companies for the first time ever and as you heard from Dr. Schlenker I spent about eight years as insurance commissioner. I used to be the head of the National Association of Insurance Commissioners. I'm pretty familiar with the health market but insurance companies have never had to compete against each other for customers based on price and service and that's really what this new market will afford. A transparent ability to compare plans and look at what is best for people and their families and moving past the days when insurance companies could either lock out or dump out or price out anyone who would get sick along the way. Now large employers have always had market protections. Employees of large employers have always been safe and secure even if they had a pre-existing health condition. So again we're talking about people who are purchasing in the individual market who have never had rules and have never been part of a larger pool. Now we've heard good news on rates as I say from states around the country and as October 1st gets closer we will have rates available for every plan in every state in the country and those will be up and running but Texans looking for coverage will find more competition. We have up to 120 insurers competing across the country in the new exchanges. We think in most states they'll have a choice of about 15 plans to choose from. In many states that have had monopoly markets for the individual market we have new carriers coming into the market who want to compete for the new customers. So the marketplace will be up and running October 1st and there'll be a lot of outreach and enrollment efforts and you'll hear a little bit more about that tonight. Now the second piece of the puzzle is really the opportunity for states around the country to expand their Medicaid program and Medicaid is really for the lowest income families and workers who may not be eligible for subsidies or can't afford private insurance coverage. Medicaid expansion clearly would reduce the burden of uncompensated care which for now is picked up by hospitals and taxpayers throughout the states and Texas is one of them. Care that right now is often paid for by local property taxes. There are significant resources that would be injected into the hospitals. I was in Austin this morning meeting with the head of the hospital association the head of the medical society was there the head of the nurses association and representative from chamber groups around the country. What the head of the hospital association told me is that on average hospitals in Texas have about 26% of their bills unpaid each and every year 26%. So those costs are absorbed by other people and often by taxpayers and property taxpayers providers deliver care each and every day that are uncompensated and their people in city jails and living under bridges who can't get access to mental health services or substance abuse services that would be made available with expanded health care. The federal government has made a very generous offer through the Affordable Care Act which is that for the first three years 2014 15 and 16 100% of the costs of newly insured would be paid for at the federal level and then gradually over the course of 10 years the federal share of the costs would decrease but nevertheless the 90% with the state ultimately at the end of 10 years picking up 10% of the costs it is fully paid for in the law signed by President Obama it doesn't add a dime to the deficit and for Texas it would mean about 90 billion dollars coming into the state over the next 10 years to help provide health coverage for some of the lowest income uninsured Texans. So we know that there are about a million and a half Texans who would qualify for new Medicaid expanded coverage if the governor and the state legislature decide to take up that offer there is no deadline the offer is on the table and we will continue to work with the state to see what the opportunities might be to look at that expanded coverage I am a recovering governor I served with Governor Perry for a couple of terms and I would tell you I would have given a lot to have had that deal in our state of Kansas that would have brought those kind of federal resources for our uninsured population if Texas chooses not to expand the Medicaid program if that decision stands then there will still be a big gap in coverage because the way the law is written no one who is below 100% of poverty qualifies for financial assistance in the marketplace it was assumed that Medicaid would cover that population so families making anywhere between under $23,000 a year would ultimately fall through those cracks and be really left without coverage be entering the doors of an emergency room to access care or just go without care altogether so expanding Medicaid isn't just the right thing to do from a health standpoint or a fiscal standpoint I think it's also the right thing to do for Texas families who are one injury or illness away from losing everything they have again there is no deadline so we're hoping this conversation will continue and that the return on investment argument that a lot of I know local chambers are making throughout the state will be compelling at the state level so I am in Texas today but visiting states around the country between now and the time open enrollment ends in March of 2014 to reach out to people who are unaware of what the law says unaware that they are going to be entitled to benefits starting October 1st and may have some opportunities for health security that they've never enjoyed before this is no longer a political debate the law was passed and signed in March of 2010 the Supreme Court upheld the laws constitutional a year ago the president was reelected this is the law that is being fully implemented and we want to make sure that people understand that there are benefits and opportunities for health security that they've never enjoyed and that they've never had an opportunity to think about about 40% of the uninsured population here in Texas are young and I am the mother of two young adults I know that they don't get up every morning thinking about health insurance many mornings I'm not sure what they get up and think about but I can pretty well guarantee you it is in health insurance but certainly getting the attention of a lot of the young and healthy population is also part of this challenge they will have an opportunity to have a catastrophic plan if they're under 30 years old that is incredibly affordable but also I think many young people who believe that nothing could ever happen to them or whatever happened to them are one accident or one diagnosis away from what could be a lifetime of health bills and more importantly a lifetime of going without life saving care so recently I was with a young bartender from Philadelphia and his story I think is the story that could be repeated in towns across Texas he's 24 year old bartender he's an uncle and a father figure to his sister's kids and one of the millions of 24 year olds around the country who thinks he can't afford health insurance and really didn't think he needed health insurance so he didn't really focus on it he had a recent situation where something went terribly wrong he heard his foot and he thought it was broken but he didn't go see a doctor because he said he couldn't afford it and he figured it would get better he is in a situation where he knows now what he did was a pretty stupid thing he will have some difficulties with that foot for a very long time he and fully intends to sign up for a health coverage when it's available but he said he wouldn't have ever thought about it unless something happened to him or unless somebody talked to him about it so we know there all kinds of people out there who may be uninsured or underinsured for so long that they don't believe that they'll ever have affordable coverage or they never thought this would be about them they're busy thinking about work or school not certainly about health insurance and we're trying to make sure that they know that on October 1st they can begin to make some good smart long-term choices for themselves and their families they can flip a switch and finally offer the health security they need so healthcare.gov and quidado de salute.gov are up and running can sign up for updates right now and information will be pushed out to people we have just opened up my account feature on the website where people can put in a username and a password and it's the first step to enrollment in the marketplace I would tell you that the website I think you'll find doesn't look like the typical government website I don't know about the rest of you but those usually aren't very user friendly and I'm not sure they've been written mostly by people who speak English as a primary language this is a user friendly consumer friendly site but we know a lot of people are not web savvy and a lot of people don't get their information at a computer so there is a toll-free hotline that is available 24 seven with a live human being on the other end who can answer questions not only in English but can make a translator available in up to 150 languages to answer questions we will have enrollment and outreach individuals available at every federally qualified health center who have already received resources to do that are in the process of hiring people we are making partnership arrangements with libraries around the country so that librarians will be available to assist folks and computers at the library will be available and then there'll be navigators individuals hired from community and outreach groups in San Antonio and communities throughout the state who will be available to answer questions and assist individuals who may need help in filling out applications so we're partnering with trusted resources and with community validators to make sure that people understand what's coming their way now nobody's better at reaching people from San Antonio than the people who live in this community this can't be driven by Washington we never intended to do this plan out of DC this is a local outreach effort and I've been so pleased to find so many willing partners and elected officials and health care providers and hospital associations and community activists they're eager to be engaged and involved again I appreciate you all being here tonight to learn some more to figure out ways that you can help inform your family your friends your employees your communities and help us build a healthier and more prosperous community it if we are going to change the health status of Americans it's going to happen city by city state by state community by community and family by family and the key to that is having engaged involved citizens who are involved and ready to take advantage of the opportunities that this new bill provides I think that we have talked in the United States about affordable health care for over 70 years presidents have attempted to pass comprehensive legislation and have never been successful this is finally the law of the land and we look forward to this historic opportunity to making sure that people across this country but here in Texas and certainly here in San Antonio understand that a new day is coming and that they have some opportunity for health security that they've never enjoyed before so thank you all for being here tonight and thank you for having me here in San Antonio