SUBJECT: Respecting the Rights of Hospital Patients to Receive Visitors and to Designate Surrogate Decision Makers for Medical Emergencies

There are few moments in our lives that call for greater compassion and companionship than when a loved one is admitted to the hospital. In these hours of need and moments of pain and anxiety, all of us would hope to have a hand to hold, a shoulder on which to lean -- a loved one to be there for us, as we would be there for them.

Yet every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides -- whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf. Also uniquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives -- unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated.

For all of these Americans, the failure to have their wishes respected concerning who may visit them or make medical decisions on their behalf has real onsequences. It means that doctors and nurses do not always have the best information about patients' medications and medical histories and that friends and certain family members are unable to serve as intermediaries to help communicate patients' needs. It means that a stressful and at times terrifying experience for patients is senselessly compounded by indignity and unfairness. And it means that all too often, people are made to suffer or even to pass away alone, denied the comfort of companionship in their final moments while a loved one is left worrying and pacing down the hall.

Many States have taken steps to try to put an end to these problems. North Carolina recently amended its Patients' Bill of Rights to give each patient "the right to designate visitors who shall receive the same visitation privileges as the patient's immediate family members, regardless of whether the visitors are legally related to the patient" -- a right that applies in every hospital in the State. Delaware, Nebraska, and Minnesota have adopted similar laws.

My Administration can expand on these important steps to ensure that patients can receive compassionate care and equal treatment during their hospital stays. By this memorandum, I request that you take the following steps:

1. Initiate appropriate rulemaking, pursuant to your authority under 42 U.S.C. 1395x and other relevant provisions of law, to ensure that hospitals that participate in Medicare or Medicaid respect the rights of patients to designate visitors. It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. You should also provide that participating hospitals may not deny visitation privileges on the basis of race, color, national
origin, religion, sex, sexual orientation, gender identity, or disability. The rulemaking should take into account the need for hospitals to restrict visitation in medically appropriate circumstances as well as the clinical decisions that medical professionals make about a patient's care or treatment.

2. Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations, codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care. Additionally, I request that you issue new guidelines, pursuant to your authority under 42 U.S.C. 1395cc and other relevant provisions of law, and provide technical assistance on how hospitals participating in Medicare or Medicaid can best comply with the regulations and take any additional appropriate measures to fully enforce the regulations.

3. Provide additional recommendations to me, within 180 days of the date of this memorandum, on actions the Department of Health and Human Services can take to address hospital visitation, medical decisionmaking, or other health care issues that affect LGBT patients and their families.

This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

You are hereby authorized and directed to publish this memorandum in the Federal Register.

BARACK OBAMA

THE PRESIDENT:  Hello, Portland!  (Applause.)  Thank you.  (Applause.)  Thank you.  (Applause.)  Thank you, Portland. 

AUDIENCE:  Yes we can!  Yes we can!  Yes we can!
 
THE PRESIDENT:  Thank you.  Thank you, everybody.  Thank you.  (Applause.)  Thank you so much.  Thank you.  Thank you, everybody. 

Well, what a wonderful -- I guess when the sun comes out around here, everybody gets pretty excited.  (Applause.)

AUDIENCE MEMBER:  I love you!

THE PRESIDENT:  I love you back.  (Applause.)

Now, I have to say, the last time I was in Maine was before the caucuses.  (Applause.)  It was a little cooler here -- (laughter) -- as I recall.  But it is wonderful to be back.  There are some people I want to say a few nice things about.

First of all, we could not have a better Small Business Administrator than your own neighbor, Karen Mills.  And so please give her a huge round of applause.  (Applause.)  She’s doing a great job.  I think she has more than a few folks from Maine on her staff.  She’s kind of stocked them all over the place.  And everybody is doing a great job over at the SBA.  I want to thank --

AUDIENCE MEMBER:  Thank you!

THE PRESIDENT:  Thank you.  (Applause.)  I want to thank one of the finest governors in the country, John Baldacci, who is here.  (Applause.)  Thank you, John.  Where is he?  There he is right there.  Thank you.  (Applause.)

Your outstanding mayor Nick Mavodones is here.  (Applause.)  And we’ve got two great champions from Maine whose tireless efforts have helped working families all across this state and all across this country -- Congresswoman Chellie Pingree and Congressman Mike Michaud.  (Applause.)

All right, it is good to be back in Maine.  (Applause.)  And I want everybody to remember, when I came here during the campaign, I made a promise.  And it wasn’t a promise about any particular issue.  It was a promise that our government would once again be responsive to the needs and aspirations of working families, of America’s middle class.  It was a promise that Washington would concern itself not just with the next election, but with the next generation of Americans.  (Applause.) 

Now, keeping that promise is even more critical now, at a time when so many families and so many small business owners are still struggling here in Maine and all across the country.  Every time I visit with workers in a factory, or families in a diner; every time I sit down and read letters from Americans across the country, I see and hear the same questions.  Folks are asking, “How am I going to find a job when I’ve only known one skill my entire lifetime and I just got laid off and I'm in my fifties?  How am I going to retire when I keep spending my savings just to get by, or trying to make sure that my kid can go to college and tuition keeps on going up?  How am I going to make it when I'm stretched to the limits on my mortgage and on my bills?”  Those are the questions that I hear.

And I want you to know we are working every single day to spur job creation and to turn this economy around.  That’s why we worked so hard over the last year to lift one of the biggest burdens facing middle-class families and small business owners, and that is the crushing cost of health care right here in America.  (Applause.) 

And Mainers, I want you to know that last week, after a year of debate and a century of trying, health insurance reform became the law of the land -- last week.  (Applause.)  Last week.

AUDIENCE:  Yes we did!  Yes we did!  Yes we did!

THE PRESIDENT:  Yes we did.  Because of folks like Chellie and Mike, it happened.  (Applause.)  Because of people like you, it happened.  It happened because people had the courage to stand up at town hall meetings and talk about how insurance companies were denying their families coverage because of a preexisting condition.  It happened because folks wrote letters about how premiums have gone up 50 or 70 or 100 percent, in some cases, and it was forcing them to give up their insurance.  It happened because countless small business owners and families and doctors shared stories about a health care system that was working better for the insurance industry than it did for American people.

And when the special interests sent an army of lobbyists to Congress and blanketed the airwaves with millions of dollars in negative ads, all of you mobilized and organized and you refused to give up.  And when the pundits were obsessed over what the polls were saying and who was up and who was down, and what would this mean for Democrats or Republicans, you never lost sight of what was right and what was wrong.  (Applause.)  You knew it wasn’t about the fortunes of one party, it was about the future of our country.  (Applause.)  And today, Portland, because of what you did, the future looks stronger and more hopeful than it has in some time.

Now, over the last year, there’s been a lot of misinformation spread about health reform.  There’s been a lot of fear-mongering, a lot of overheated rhetoric.  You turned on the news, you’d see that those same folks who were hollering about it before it passed, they’re still hollering, about how the world will end because we passed this bill.  (Laughter.)  This is not an exaggeration.  John Boehner called the passage of this bill --

AUDIENCE:  Booo!

THE PRESIDENT:  -- no need to -- we don’t need to boo, I just want to give the facts -- called this passage of this bill “Armageddon.”  You had others who said this is the end of freedom as we know it.

So after I signed the bill, I looked around.  (Laughter and applause.)  I looked up at the sky to see if asteroids were coming.  (Laughter.) I looked at the ground to see if cracks had opened up in the earth.  You know what, it turned out it was a pretty nice day.  (Laughter and applause.)  Birds were still chirping.  Folks were strolling down the street.  Nobody had lost their doctor.  Nobody had pulled the plug on Granny.  (Laughter.)  Nobody was being dragged away to be forced into some government-run health care plan. 

But the thing is, though, you have to love some of the pundits in Washington.  Every single day since I signed the reform law, there’s been another poll or headline that said “Nation still divided on health care reform.  Polls haven’t changed yet.”  Well, yeah.  It just happened last week.  (Laughter and applause.)  It’s only been a week.  (Applause.)

Can you imagine if some of these reporters were working on a farm?  (Laughter.)  You planted some seeds, and they came out the next day, and they looked, and nothing’s happened!  (Laughter and applause.)  There’s no crop!  We’re going to starve!  Oh, no!  (Applause.)  It’s a disaster!  (Laughter.)

It’s been a week, folks.  (Laughter.)  So before we find out if people like health care reform, we should wait to see what happens when we actually put it into place.  Just a thought.  (Applause.)

Now, look, this reform is not going to solve every problem with our health care system.  It is a huge, complicated piece of business -- a couple of trillion dollars, thousands of people affected, thousands of people working in the industry.  It’s not going to bring down the cost of health care overnight.  We’re going to have to make some adjustments along the way.  But it represents enormous progress.  It enshrines the principle that every American should have the security of decent care; and that nobody should go bankrupt because they’ve got a kid who’s sick with a preexisting condition -- (applause) -- that small businesses shouldn’t be burdened because they want to do the right thing by their employee.  So now that this bill is finally law and all the folks who have been playing politics will finally have to confront the reality of what this reform is, they’re also going to have to confront the reality of what it isn’t. 

They’ll have to finally acknowledge that this isn’t a government takeover of our health care system.  They’ll see that if Americans like their doctor, they will keep their doctor.  And if you like your insurance plan, you will keep it.  No one will be able to take that away from you.  It hasn’t happened yet.  It won’t happen in the future.     

What this reform represents is basically a middle-of-the-road solution to a very serious problem.  It’s not single-payer. Some people wanted that, I understood that, but that is not -- (applause) -- see?  But -- so it’s not that.  But it’s also not what the Republicans were advocating for, which is essentially that you completely deregulate the insurance industry, you let them run wild, and that somehow you are going to benefit.  That was their theory.  It was called the “foxes guarding the chicken coop” health care plan.  (Applause.)

So it’s not the plan that some on the left supported in the past.  It’s not what some on the right supported, but it is a commonsense plan.  This reform incorporates ideas from both Democrats and Republicans -– including, by the way, a number of ideas from your senator and somebody I consider a friend, Olympia Snowe, who spent many hours meeting with me on this bill.  (Applause.)    

And what this reform does is it builds on the system of private health insurance that we’ve already got, so that if you have insurance, this reform will make it more secure and more affordable.  If you can’t afford insurance or if you’ve been denied coverage, you’re finally going to be able to get it.  And over time, costs will come down for families, businesses, and the federal government, reducing our deficit by more than $1 trillion over the next two decades.  That’s what this reform will do.  (Applause.)

Now, Portland, it will take about four years to implement this entire plan, because we’ve got to do it responsibly, we need to get it right.  But there’s also a set of reforms that will take effect this year.  So I just want to -- I want everybody to understand what’s going to happen this year.

Starting this year, millions of small business owners are going to be eligible for a tax credit that will help them cover the cost of insurance for their employees.  (Applause.)  And let me talk about -- let me talk about what this means for a small business owner like Bill Milliken.  (Applause.)  Bill, stand up.  (Applause.)  That’s Bill right there.  (Applause.)  Now, I want to give a little plug to Bill here.  (Laughter.)  Bill owns Market House Coffee and the Maine Beer and Beverage Corporation, both here, right here in Portland.  (Applause.)  In exchange for this publicity, I hope that I'm going to get some samples of the beer.  (Laughter and applause.)  Okay.  He nodded in the affirmative.  (Laughter.)

Now, he wants to give his part-time employees health insurance and he wants to give them more hours, but he can’t do both, he can’t afford to do both.  So this tax credit will make it easier for an employer like Bill who wants to do the right thing by his workers. 

Starting now, small business owners like Bill will have the security of knowing that they can qualify for a tax credit that covers up to 35 percent, over a third of what they pay for their employees’ health insurance.  And starting now -- (applause) -- starting now, small business owners that provide health care for their workers can sit down at the end of the week, they can look at their expenses, and they can begin calculating how much money they’re going to save.  And for small business owners who don’t currently provide health insurance, they’re going to be able to factor in this new benefit when they’re deciding to do so. 

Now, it won’t solve all our problems, but it means that employees that work for Bill have a better chance of keeping their health care or getting health care.  And if they’re already getting health care, it means Bill has got some extra money.  That means he might hire that extra worker, right?  (Applause.) 

     So this health care tax credit is pro-jobs, it’s pro-business, and it starts this year.  (Applause.)  This month, we’re going to be -- this month we’re going to be sending out details on how to apply for this credit to millions of small businesses across the county, but if you want to learn about it today, we’re going to put all the facts on our Web site, www.whitehouse.gov.  All right?  So that happens this year.      

Here’s what else happens this year.  Tens of thousands of uninsured Americans with preexisting conditions, and parents whose children have a preexisting condition, will finally be able to purchase the coverage that they need.  That happens this year.  (Applause.)

So last week, I met a man named David Gallagher, whose daughter Lauren had written me a letter last year.  When Lauren’s mom lost her job, their entire family lost their health insurance.  When they tried to get new insurance, David was denied coverage because he once had a complication-free hernia surgery, but the insurance companies wanted to weed him out.  They figured, well, the guy has been sick before; we don’t want to have to cover him, we don’t want to bear that risk.  So Lauren has been worried sick about what would happen if her father became ill or injured.  Now, because of this reform, David Gallagher can finally have access to health insurance again.  That begins this year.  That starts this year.  (Applause.)     

So that’s just one of the insurance reforms that starts this year.  Here’s what else happens:  Insurance companies won’t be able to drop people’s coverage when they get sick; or place lifetime limits or restrictive annual limits on the amount of care they can receive.  (Applause.) 

Now, this isn’t some abstract concept.  There was a story in a local paper this week about a woman named Theresa D’Andrea.  And Theresa’s husband --

AUDIENCE MEMBER:  D’Andrea.

THE PRESIDENT:  D’Andrea, excuse me.  Thank you.  Where is she?  Are you up there?  Stand up.  Stand up, Theresa.  (Applause.)  Now, Theresa’s husband passed away recently from cancer, and before he died, he hit the lifetime cap on his insurance.  As a result, Theresa has not only had to cope with the loss of her husband, but with $60,000 in medical bills –- and this is after she’s already spent all of their retirement savings on medical care.  Now, because of this reform, a situation like Theresa’s won’t happen again in the United States of America.  And that’s going to start this year.  And we’re inspired by stories like yours.  (Applause.)   

Starting this year, all new insurance plans will be required to offer free preventive care.  And starting this year -- this may interest some of you here -- if you are a young person who doesn’t have insurance or doesn’t have a job that offers insurance, you’re going to be able to stay on your parents’ insurance policy until you’re 26 years old, starting this year.  Starting this year.  (Applause.)  So now --

AUDIENCE MEMBER:  Thank you.

THE PRESIDENT:  You’re welcome.  (Laughter.)  Thank Chellie and Mike.  They voted for it.  Thank them.  (Applause.)

This year, seniors who fall into the coverage gap known as the doughnut hole -- some seniors probably know about that -- they’re going to receive $250 to help pay for prescriptions, and that’s just the first step, because what we’re going to be doing is over the next several years closing that gap completely.  And I want seniors to know -- (applause) -- I want seniors to know despite some of the stuff that’s been said out there, these reforms don’t cut into your guaranteed benefits.  What they do is eliminate co-payments and deductibles for preventive care, like check-ups and mammograms.  You will be getting those for free now.  (Applause.) 

This is why AARP supported this bill -- because it’s good for seniors.  It’s the right thing to do.  (Applause.)  It’s good for young people.  It’s the right thing to do.  (Applause.)  It’s good for people who’ve hit these lifetime limits.  It’s good for people with preexisting conditions.  All that -- all that happens this year. 

And then, by 2014, each state will set up what we’re calling a health insurance exchange, but it’s basically just a competitive marketplace where uninsured people and small businesses, who right now are out there on their own trying to negotiate with insurance companies, they can now be part of a big pool -- millions of people coming together, leveraging their purchasing power, which is going to lower their rates.  They’ll get a better deal.

Walmart, the reason they are able to give you low prices is because they buy and they tell their suppliers, we’re the biggest -- we’re a 800-pound gorilla when it comes to whatever product you’re talking about, so you’ve got to give better prices.  Well, the same thing is true when it comes to the insurance markets.  So everybody who can be part of this pool is going to get a better deal than they would otherwise get.

And by the way, members of Congress are going to be part of this pool.  So you know it’s going to be good because they’re going to have to use it themselves for their own families.  (Applause.) 

So that’ll happen in the next few years.  And when this exchange is up and running, millions of people are also going to get tax breaks to help them afford coverage.  So even though this pool will give you lower rates, you’ll get a better deal, some folks still can’t afford it.  So we’re going to give you tax credits to help you afford it.  And that adds up to the largest middle-class tax cut in health care in history.  That’s what this bill is about.  (Applause.) 

So think about it.  So think about it.  That’s what this is about.  We’re setting up a pool using the private market to give people a better deal.  We’re giving tax breaks to working people -- some of them working two, three jobs who still can’t get insurance -- we’re going to give them some help.  We’re going to give small businesses help so that they can help their workers and improve their bottom line.  And we’ve got a whole bunch of insurance reforms so people like Theresa aren’t going to be disadvantaged and taken advantage of when they need it most.  That's what this bill is.  And it’s paid for.  And it saves on our deficits.  (Applause.)

     Now, this is what everybody has been hollering about as the end of freedom.  (Laughter.)  And now that it’s passed, they’re already promising, we’re going to repeal it. 

AUDIENCE:  Boo!

THE PRESIDENT:  They’re going to run on a platform of repeal in November.  And my attitude is, go for it.  You try to repeal it.  (Applause.)

     I want these members of Congress to come out of Washington, come here to Maine, and tell Mr. Milliken there, you know what, we’re going to take away your tax credits, essentially raise your taxes.  If you want to -- if they want to do that, be my guest. 

If they want to look at Lauren Gallagher in the eye and tell her they plan to take away her father’s ability to get health insurance, that’s their right.  If they want to go tell Theresa that once again you could face a lifetime of debt if you lose a family member, they can run on that platform.
 
If they want to have a fight, I welcome that fight, because I don’t believe the American people are going to put the insurance industry back in the driver’s seat.  I’m happy to have that argument.  (Applause.)  I’m happy to have that argument. 

Now, in fairness -- and I want to be scrupulously fair -- some of them have now said, well, we want to repeal and replace this bill with our brand of insurance reform.  But when you poke and prod and you ask them, well, what is it exactly you’re going to replace it with, it turns out they want to deregulate the insurance market.  We’ve already been there.  We know what that’s like.  We’re not going back.  We’re not going backwards.  This country is ready to move forwards.  Portland, Maine, is ready to move forward.  (Applause.) 

And while we’re talking about moving forward, I just want to mention one thing.  Kind of lost in the shuffle of all this health care debate is the fact that part of the bill that we signed, that I signed this week, is going to provide an additional $68 billion that used to go to banks and financial services companies, and that’s now going to go to the student loan program to expand Pell Grants and to make sure that college is affordable for every young person in America.  (Applause.)  And I want to know, do they want to repeal that as well, because I'm happy to have that discussion.  (Applause.) 

Now, $68 billion -- $68 billion -- was going to banks and financial institutions.  We’ve just taken that money from the banks, from the financial institutions, doubling Pell Grants, making sure that -- making sure that young people, if you’ve got debt when you go out of college -- and I know I did so you probably do, too -- that you will never have to pay more than 10 percent of your income in repayments -- (applause) -- so that you’re not going broke because you decide to get a college education that makes our economy stronger, that makes America stronger.  If they want to repeal that, too, we can have that discussion.  (Applause.) 

The road to this victory has been long.  It has been -- it has been difficult.  And it’s absolutely true that because health care is such a complicated issue, a lot of people got worried.  A lot of people got scared.  And the misinformation seeped in.  And then the process was ugly and everybody was arguing and there was all kinds of stuff going on in the Senate and the House, and everybody just said, ah, this looks like a mess.

I understand that.  That’s part of our democracy.  This is a -- democracy is a messy business.  It is the worst form of government except for all the other ones that have been tried.  (Laughter and applause.)  That’s what Winston Churchill said.  That’s what Winston Churchill said -- he’s absolutely right.  It can be frustrating sometimes, but ultimately that’s what makes our country so great, is because everybody is able to voice their opinions; everybody is able to get out there and organize.  (Applause.)  And you’re free to call your President an idiot.  (Laughter.) 

AUDIENCE:  Booo!

THE PRESIDENT:  No, that’s a wonderful thing.  As I was driving by, people were waving.  Everybody was clapping.  And then one guy’s like “Eh.”  (Laughter.)  He saw me through the window, too, going, “Eh.”  (Laughter.)  I thought, that’s a great thing about the country.  (Applause.) 

Look, but I want everybody to learn the lesson from this debate.  In reaching this milestone, it doesn’t represent the end of all our problems.  We still have jobs to create and deficits to reduce.  We still have children to educate.  We still face enormous challenges in this country.  Jobs haven’t been returning fast enough, despite everything that we’re doing.  The economy is growing again, but people still haven’t been hired back as fast as they need to.  Small businesses are still having trouble getting credit out there.  So there are all kinds of issues we’re going to have to work on. 

But what this fight has taught us about ourselves and about this country -- it’s bigger than any one issue.  It reminds us that change is never easy, but it’s always possible.  It reminds us that in the United States of America, we still have the power to shape our own destiny.  And it reminds us that we, as a people, don’t shrink from a challenge.  We don’t shirk our responsibilities.  We embrace challenges.  (Applause.)  We don’t fear the future.  We shape the future.  That’s what we do.  That’s who we are.  That’s what you’re about.  That's why you’re here.  That's why I ran for President of the United States of America.  That's what makes us the United States of America.  (Applause.) 

     Thank you, Portland.  God bless you.  God bless the United States of America.  (Applause.)

END
3:51 P.M. EDT

Key Facts about the Small Business Health Care Tax Credit

Key Elements

Getting the Word Out to Small Businesses

To ensure that small businesses know about the credit and how to claim it, the Administration is initiating a nationwide educational campaign for small businesses and tax preparers. 

Benefit from Small Business Health Care Tax Credit: Four Cases

Example 1: Auto Repair Shop with 10 Employees Gets $24,500 Credit for 2010

Main Street Mechanic:

2010 Tax Credit: $24,500 (35% credit)
2014 Tax Credit: $35,000 (50% credit)

Example 2: Restaurant with 40 Part-Time Employees Gets $28,000 Credit for 2010

Downtown Diner:

2010 Tax Credit: $28,000 (35% credit with phase-out)
2014 Tax Credit: $40,000 (50% credit with phase-out)

Example 3: Foster Care Non-Profit with 9 Employees Gets $18,000 Credit for 2010

First Street Family Services.org:

2010 Tax Credit: $18,000 (25% credit)
2014 Tax Credit: $25,200 (35% credit)

Example 4: Manufacturing Company with 12 Employees Gets $14,700 Credit for 2010

Acme Air Conditioning, LLC:

2010 Tax Credit: $14,700 (35% credit with phase-out)
2014 Tax Credit: $21,000 (50% credit with phase-out)

Five Additional Ways Health Reform will Help Small Businesses.  Small businesses want to provide health coverage for their workers, but they face extraordinary challenges in doing so, including premiums that are 18 percent higher on average than large businesses pay for the same coverage.   Health reform legislation signed by the Presidents includes a number of important benefits to help make coverage more affordable:

1. Creates Health Insurance Exchanges to Increase Bargaining Power and Reduce Administrative Costs. 

2. Ends Price Discrimination against Small Businesses with Sick Workers.

3. Increases Health Care Security to Unlock Entrepreneurship. 

4. Reduces the Hidden Tax on Small Business Employees with Health Insurance. 

5. Reduces Premiums in the Small Group Market.

The credit rates are lower for non-profits to ensure that the value of the credit is approximately equal to that provided to for-profit firms that cannot claim a tax deduction for the amount of the credit claimed.

AUDIENCE MEMBER:  Fired up!

THE PRESIDENT:  Fired up!  (Laughter.)

AUDIENCE MEMBER:  Obama!  (Laughter.)   

DR. BIDEN:  Good morning, everyone, and thank you for being here today.  I’m Jill Biden and I am honored to be a community college instructor. (Applause.)  I have been a teacher for almost three decades and a community college instructor for the past 16 years.  In fact, I’m an English teacher right here on this campus.  (Applause.)  It’s my great pleasure to welcome you all to Northern Virginia Community College.  (Applause.) 

Last week, our President signed an historic health care bill that will provide quality, affordable medical care for millions of Americans.  (Applause.)  Today we are here to celebrate another historic piece of legislation -- one that will make a college education a reality for millions of middle-class Americans.  (Applause.) 

All of us here today know that higher education is essential to the success of our children and vital to the economic future of our country.  But too many American families, they’ve had to take on crushing debt to pursue a college degree.  I see every day in my classroom just how hard my students work in order to pay their tuition bills.  Often their family budgets are stretched to the limit.  And when things get tough -- someone loses a job or a family member gets sick -- a college education is the first thing to go.

Thanks to the leadership of President Obama, our Vice President, and members of Congress here today, families across the country will find it a little easier to get to college and stay in college.  (Applause.)   

I am pleased to say that the reforms in this bill will make a huge difference to those Americans who need it most.  The expansions in Pell Grants will provide critical financial support to millions of middle-class Americans who are struggling with the costs of college.  The caps on student loan repayments will ensure that our students don’t go broke because they chose to pursue a college education.  And I am particularly thrilled that this bill invests in community colleges across our country so that more students can gain the knowledge and technical job skills that they need to compete and succeed.

I have seen firsthand the power of community colleges to change lives and serve as a gateway to opportunity for students at all stages of their lives and careers.  This bill increases investments in community colleges around the country to help these institutions do what they do best -- prepare our students for the workforce of today and tomorrow.

The President has set an ambitious goal for higher education in this country.  By 2020, we want America once again to have the highest proportion of college graduates in the world.  (Applause.)  To make this happen, we’ll need to invest in these students and invest in the colleges that they will attend.

The bill that President Obama will sign here today is a huge step forward toward meeting our goal.  I can't think of a better investment in America’s future.

I’m proud to be here as a community college instructor, and I am especially proud and honored to introduce a President who is making higher education a reality for millions more Americans.

Please welcome President Barack Obama.  (Applause.) 

THE PRESIDENT:  Thank you, Alexandria!  Thank you very much. (Applause.)  Thank you.  Thank you so much.  Thank you, everybody.  (Applause.)  Please, have a seat.

Thank you, Dr. Biden, for that outstanding introduction and for putting up with Joe.  (Laughter.)  I want to also thank Dr. Biden for being one of the thousands of instructors all across the country who make such a difference in the lives of students each and every day.  So we are very proud of you for that.  (Applause.)

I want to thank President Templin and the entire NOVA Community College family for hosting us here today -- you can applaud for that.  (Applause.)

On stage we’ve got a couple of my outstanding Cabinet members:  Secretary Sebelius and Secretary Arne Duncan -- please give them a big round of applause.  (Applause.)  In the audience we’ve got Secretary Salazar of Interior; Secretary Donovan of HUD; and Ambassador Ron Kirk, our U.S. Trade Representative -- please give them a big round of applause.  (Applause.)

To all the outstanding members of Congress who made this day possible -- and I'm going to mainly single out the amazing Speaker of the House, Nancy Pelosi.  (Applause.) 

Today, we mark an important milestone on the road to health insurance reform and higher education reform.  But, more broadly, this day affirms our ability to overcome the challenges of our politics and meet the challenges of our time.

When I took office, one of the questions we needed to answer was whether it was still possible to make government responsive to the needs of everyday people, middle-class Americans, the backbone of this country; or whether the special interests and their lobbyists would continue to hold sway, like they’ve done so many times before.  And that’s a test we met one week ago, when health insurance reform became the law of the land in the United States of America.  (Applause.) 

And it’s a test we met later in the week when Congress passed higher education reforms that will have a tremendous impact on working families -- and America’s future.  That’s two major victories in one week that will improve the lives of our people for generations to come.  (Applause.)

Now, I’ve said before and I’ve repeated this week the health insurance reform bill I signed won’t fix every problem in our health care system in one fell swoop.  But it does represent some of the toughest insurance reforms in history.  It represents a major step forward towards giving Americans with insurance -– and those without -– a sense of security when it comes to their health care.  It enshrines the principle that when you get sick, you’ve got a society there, a community, that is going to help you get back on your feet.  It represents meaningful progress for the American people.

And today, I’m signing a bill that will make a number of improvements to these core reforms.  We’ll increase the size of tax credits to help middle-class families and small businesses pay for their health insurance.  (Applause.)

We’re going to offer $250 to seniors who fall in the Medicare coverage gap known as the doughnut hole to help them pay for prescriptions, and that’s a first step towards closing that gap completely.  (Applause.) 

We’ll make a significant new investment in community health centers all across America that can provide high-quality primary care to people who need it most.  (Applause.)  And we’ll strengthen efforts to combat waste and fraud and abuse, to make sure your dollars aren’t lining the pockets of insurance companies when they should be making your health care better.  (Applause.)

Now, the debate on health care reform is one that’s gone on for generations, and I’m glad -- I’m gratified that we were able to get it done last week.  But what’s gotten overlooked amid all the hoopla, all the drama of last week, is what happened in education -- when a great battle pitting the interests of the banks and financial institutions against the interests of students finally came to an end.  (Applause.) 

You see, for almost two decades, we’ve been trying to fix a sweetheart deal in federal law that essentially gave billions of dollars to banks to act as unnecessary middlemen in administering student loans.  So those are billions of dollars that could have been spent helping more of our students attend and complete college; that could have been spent advancing the dreams of our children; that could have been spent easing the burden of tuition on middle-class families.  Instead, that money was spent padding student lenders’ profits.

Now, it probably won’t surprise you to learn that the big banks and financial institutions hired a army of lobbyists to protect the status quo.  In fact, Sallie Mae, America’s biggest student lender, spent more than $3 million on lobbying last year alone.

But I didn’t stand with the banks and the financial industries in this fight.  That’s not why I came to Washington.  And neither did any of the members of Congress who are here today.  We stood with you.  We stood with America’s students.  (Applause.)  And together, we finally won that battle. 

I don’t have to tell folks here at NOVA why this victory matters.  In the 21st century, when the success of every American hinges more than ever on the quality of their education, and when America’s success as a nation rests more than ever on an educated workforce that is second to none, we can’t afford to waste billions of dollars on giveaways to banks.

We need to invest that money in our students.  We need to invest in our community colleges.  We need to invest in the future of this country.  We need to meet the goal I set last year and graduate more of our students than any other nation by the year 2020.  And through the extraordinary leadership of Education Secretary Arne Duncan, that’s what the reforms I’m signing today will help us do.  (Applause.) 

     By cutting out the middleman, we’ll save American taxpayers $68 billion in the coming years -- $68 billion.  That’s real money -- (laughter) -- real savings that we’ll reinvest to help improve the quality of higher education and make it more affordable.

Now, we’ve already taken a number of steps through the Recovery Act and through my budget to significantly increase the support provided to young people attending colleges and universities all across the country. 

And I just -- President Templin handed me a sheet just as I walked in.  Just in case you’re wondering whether this makes a difference, so far this year -- and the year isn’t over -- right here at NOVA, Pell Grant recipients increased by 41 percent over last year.  (Applause.)  The total dollar amount of Pell Grants increased by 59 percent.  The number of federally guaranteed loans increased by 43 percent and loan awards increased by 68 percent.  That’s right here at this one community college, because of the steps that we had already taken.  (Applause.)

So using the $68 billion that we’re saving, that had been going to the banks, here’s what we’re going to be able to do.  First, we will reinvest a portion of those savings to upgrade our community colleges, which are one of the great, undervalued assets in our education system.  (Applause.) 

Community colleges like NOVA are incredibly important because they serve a varied group of learners, from recent high school grads seeking a pathway to a college degree, to adults seeking training for the jobs of tomorrow.  By forging private sector partnerships, community colleges can offer students the education and training they need to find a good job when they graduate -- and it helps offer businesses the assurance they need that graduates will be ready for the jobs that they’re hired to do.

And because community colleges like NOVA are so essential to a competitive workforce, I’ve asked your outstanding professor, Dr. Jill Biden -- who does not have enough to do -- (laughter) -- to host a summit on community colleges at the White House this fall.  And we’re going to bring everybody together, from educators to students, experts to business leaders.  (Applause.) We are going to bring everybody together to share innovative ideas about how we can help students earn degrees and credentials, and to forge private sector partnerships so we can better prepare America’s workforce and America’s workers to succeed in the 21st century.

Now, to help open the doors of higher education to more students, we’ll also reinvest part of that $68 billion in savings in Pell Grants, one of the most popular forms of financial aid.  Pell Grants once covered more than three-quarters of the cost of going to college.  But now, because the cost of college has skyrocketed, the amount Pell Grants cover is about one-third.
 
Today, students hoping to attend college on a Pell Grant are going to be able to feel more secure, because not only are we going to offer over 800,000 additional Pell awards over the next 10 years, we’re also going to raise the amount they’re worth to almost $6,000, so that inflation doesn’t erode the value of your grant.  (Applause.) 

And we’ll put the entire Pell Grant program on firmer footing for years to come.  Altogether, we are more than doubling the amount of Pell Grant funding that was available when I took office –- it’s one of the most significant investments in higher education since the G.I. Bill.  (Applause.)

Now, third, we’re going to restore a measure of fairness to how students repay their loans.  Today, two out of every three students graduates with help from a loan, and often they take on a mountain of debt as a result.  Here in Virginia, the typical student carries almost $20,000 in debt.  Across the country, the average student graduates with over $23,000 in debt.  I know what that’s like.  Michelle and I had big debts coming out of school  -- debts we weren’t able to fully repay until just a few years before I started running for office.

Today, we’re making it easier for responsible students to pay off their loans.  Right now, if you’re a borrower, you don’t have to spend more than 15 percent of your income on loans.  But starting in 2014, you won’t have to pay more than 10 percent of your income in repaying your student loans.  (Applause.)  That will make a meaningful difference for over one million more students.  We’re also going to give students an incentive to do what’s right -- if you pay your loans on time, you’ll only have to pay them off for 20 years.  And you’ll only have to pay them off for 10 years if you repay them with service to your community, and to our country, as a teacher or a nurse or a member of our Armed Forces.  (Applause.) 

Finally, we’ll reinvest some of the $68 billion in savings to strengthen our Historically Black Colleges and Universities and Minority Serving Institutions.  (Applause.)  These are institutions that have struggled more than most in these tough economic times.

The reforms in this bill are significant, but they’re just part of a broader effort to strengthen our entire higher education system.  We’re putting college tuition tax credits in the pockets of millions of students from working families to help them pay for college.  We’ve taken steps to simplify the federal college assistance form -– called the FAFSA -– because it shouldn’t take a PhD to apply for financial aid.  (Applause.)  And we’re helping ensure that America’s high school graduates are ready for college.  All of this is paid for.  We’re redirecting money that was poorly spent to make sure we’re making investments in our future.

Now, this won’t solve all of our problems in higher education.  We continue to expect colleges and universities to do their part to hold down tuition increases.  (Applause.)  That has to happen.  We’ve got to work on that.  And we also need to take greater initiative not only to help more students enter college, we’ve got to make sure that we see more students successfully earn a college degree.  But what we’ve done over the past year represents enormous progress.

So I’ll close by saying this.  For a long time, our student loan system has worked for banks and financial institutions. Today, we’re finally making our student loan system work for students and our families.  But we’re also doing something more.
From the moment I was sworn into office, I’ve spoken about the urgent need for us to lay a new foundation for our economy and for our future.  And two pillars of that foundation are health care and education, and each has long suffered from problems that we chose to kick down the road.

With the bill I signed last week, we finally undertook meaningful reform of our health care system.  With this bill, and other steps we’ve pursued over the last year, we are finally undertaking meaningful reform in our higher education system.  So this week, we can rightly say the foundation on which America’s future will be built is stronger than it was one year ago.  (Applause.) 

And so at the end of this extraordinary week, I want to acknowledge some of the people who made it possible.  There isn’t time to single out everyone who’s here, the outstanding members of Congress, but I want to make sure I once again say this would not have happened had it not been for the leadership of Speaker Nancy Pelosi -- (applause) -- Senate Majority Leader Harry Reid  -- (applause) -- Senator Dick Durbin and Congressman Steny Hoyer. All provided outstanding leadership that our nation needed.  (Applause.) 

On health care, Max Baucus, Chris Dodd, Henry Waxman, Charlie Rangel, and so many others offered invaluable expertise throughout the year.  (Applause.)  Congressmen George Miller, Jim Clyburn, Dale Kildee, Ruben Hinojosa led the way in the House on education reforms that I sign today.  (Applause.) 

Senator Tom Harkin’s dedication ensured that the Senate would include these reforms in this bill.  (Applause.)  Virginia’s own Bobby Scott, and an outstanding freshman, Tom Perriello helped to make this thing possible.  (Applause.)  We are grateful to them.

Courage is an essential ingredient in any landmark legislation, particularly when the attacks are as fierce and unrelenting -- and inaccurate -- (laughter) -- as they have been over the past year.  I just want to commend members of Congress who had the courage to do what’s right -- (applause) -- and to say a special thank you to all of the newer members.  (Applause.) 
The past couple of years have brought one challenge after another, and you’ve risen to the moment each time.  I could not be prouder of the work that all of you have done.  And it would not have happened had it not been for the incredible persistence and stick-to-itiveness of all the folks in the audience here today. 

Ultimately, Congress responds to the voices that they’re hearing in their communities, and so many of you have written letters and come to meetings and let people know of the ordinary struggles that people are going through each and every day.  You’re what provided members of Congress the courage that they needed to do what was right.  And so on behalf of all of us who are serving in Washington, we want to thank you, the American people, for your outstanding leadership.  (Applause.)  

And with that, I’m going to sign this bill.  Thank you very much.  (Applause.)

(The bill is signed.)  (Applause.) 

END
11:32 A.M. EDT

WASHINGTON, D.C. – Today, President Obama signed the Health Care and Education Reconciliation Act of 2010, which delivered a significant down payment on the President’s ambitious agenda to make higher education more affordable and help more Americans earn a college degree. 

This legislation strengthens the Pell Grant program, invests in community colleges, extends support for Historically Black Colleges and other Minority Serving Institutions, and helps student borrowers manage their student loan debt by capping repayments at 10% of their discretionary income.   These efforts will be fully paid for by ending the government subsidies currently given to banks and other financial institutions that make guaranteed federal student loans and free up nearly $68 billion for college affordability and deficit reduction over the next 11 years.

“For a long time, our student loan system has worked for banks and financial institutions,” President Obama said.  “Today, we’re finally making our student loan system work for students and all of our families.”

“This legislation is a win for students and parents struggling to make ends meet to fulfill the dream of a college education,” Education Secretary Arne Duncan said.  “By ending subsidies to banks, we can make important investments that increase affordability and access to our nation’s universities and community colleges.”

This historic law:

Starting July 1, all new federal student loans will be direct loans, delivered and collected by private companies under performance-based contracts with the Department of Education. According to the non-partisan Congressional Budget Office, ending these wasteful subsidies will free up nearly $68 billion for college affordability and deficit reduction over the next 11 years.

Click HERE for more information and fact sheets on this historic legislation.

THE PRESIDENT:  Hello, Iowa!  (Applause.)  Are you fired up?  (Applause.)  Oh, it is good to be back in Iowa.  (Applause.)  I got to take off my jacket when I'm in Iowa.  (Applause.)  It is good to be back in Iowa.  It’s a little colder than it is in D.C., I got to admit.  (Laughter.)  But I can feel spring coming.

I want to make a couple of acknowledgements.  First of all, University of Iowa President Dr. Sally Mason and the entire Hawkeye community, thanks for hosting us.  (Applause.)  The outstanding governor of the great state of Iowa, Chet Culver and First Lady Mari Culver.  (Applause.)  There he is back there.

A couple of great friends, Lieutenant Governor Patty Judge.  (Applause.)  The cochairs of my campaign here in Iowa, Attorney General Tom Miller and Treasurer Mike Fitzgerald.  (Applause.)  The former governor of Iowa who is now I think going to end up being one of the greatest Secretaries of Agriculture in history, Tom Vilsack is in the house.  (Applause.)

I want to acknowledge Iowa City Mayor Matt Hayek.  (Applause.)  The entire Iowa delegation could not be here because they are still busy finishing business, crossing “T’s” and dotting “I’s” in Washington.  But I want every single person to know that this celebration would not be happening if it were not for your members of Congress, Leonard Boswell, Bruce Braley, your own personal congressman, Dave Loebsack -- (applause) -- and Senator Tom Harkin.  (Applause.)

Now, thank you Secretary Sebelius for the introduction, but more importantly, for all the amazing and tireless work that you’ve done to make health care reform a reality.  I, too, feel your pain because in my bracket -- (laughter) -- I had Kansas winning it all.  I feel a little bitter.  The President of Northern Ireland came here and he was just, big smile, he was gloating -- (laughter and applause) -- I now -- I’m sold.  I want to congratulate all the Northern Iowa fans in this part of the state on their big win.  (Applause.)  And since you ruined my bracket I'm rooting for you now.  I want you to just go ahead and take it.  (Laughter.)  Go all the way.

I also want to start things off -- oh, there’s one other thing.  Some of you know that I have a military aide that travels with me wherever I go.  This is one of the things the President does, is carries a big satchel with all kinds of important stuff in there.  And the military aide I have with me today is a guy named Lieutenant Colonel Dave Kalinske.  And Dave was strong safety for the Hawkeyes.  (Applause.)  There he is right there -- there’s Dave Kalinske.  (Applause.)  Strong safety.  See, that briefcase is big so you got to have a former strong safety carrying it.  (Laughter.)

I want to start off by telling folks here how inspired that I’ve been by your continued resilience in the wake of the floods that devastated this region a few years back.  And I remember traveling here right after they happened and how tough things were.

I know -- I know the rebuilding has been difficult, but you should know that you always have a committed partner in this administration to support the road to recovery.  (Applause.)  And we know that Iowa City is going to be as good as new and better; Cedar Rapids, all across the state we're seeing that rebuilding take place.

So it’s just good to be back in Iowa.  This is the state that first believed in our campaign.  (Applause.)  When all the pundits had written us off, when we were down in the polls, this is the state that inspired us to keep on going, even when the path was uncertain.  And because of you, this is the place where change began.  (Applause.) 

Three years ago, I came here to this campus to make a promise.  Just a few months into our campaign, I stood at the University of Iowa hospital right around the corner and I promised that by the end of my first term in office, I would sign legislation to reform our health insurance system.  (Applause.)

On Tuesday, after a year of debate, a century of trying, after so many of you shared your stories and your heartaches and your hopes, that promise was finally fulfilled.  (Applause.)  And today, health insurance reform is the law of the land all across America.  (Applause.)

AUDIENCE:  Yes we did!  Yes we did!  Yes we did!  Yes we did!  Yes we did!  Yes we did!  Yes we did!

THE PRESIDENT:  Yes, we did.  Yes, we did.  Just like the campaign that led us here, this historic change didn’t start in Washington.  It began in places like Iowa City, places just like this, with Americans just like you.

It began when people had the courage to stand up in town hall meetings and talk about how insurance companies were denying their families coverage because of a preexisting condition.

It began when folks wrote letters about how premium hikes of 40 and 50 and a hundred percent were forcing them to give up their insurance.

It began when countless small business owners and families and doctors shared stories about a health care system that works better for the insurance industry than it does for the American people.

So this is your victory, because when the special interests sent an army of lobbyists to Congress, they blanketed the airwaves with millions of dollars of negative ads, you mobilized and you organized and you refused to give up.  And when the pundits were obsessing over who was up and who was down and how is this affecting the Obama administration and what’s going on over in the House, you never lost sight of what was right and what was wrong.  You knew this was not about the fortunes of one party -- this was about the future of our country.  (Applause.)  And today, because of what you did, that future looks stronger and more hopeful and brighter than it has in some time -- because of you.  (Applause.)

Three years ago, we made a promise.  That promise has been kept.  Of course -- of course, over the last year, there’s been a lot of misinformation spread about health care reform.  There’s been plenty of fear-mongering, plenty of overheated rhetoric.  You turn on the news, you’ll see the same folks are still shouting about there’s going to be an end of the world because this bill passed.  (Laughter.)  I’m not exaggerating.  Leaders of the Republican Party, they called the passage of this bill “Armageddon.”  (Laughter.)  Armageddon.  “End of freedom as we know it.”

So after I signed the bill, I looked around to see if there any -- (laughter) -- asteroids falling or -- (applause) -- some cracks opening up in the Earth.  (Laughter.)  It turned out it was a nice day.  (Laughter.)  Birds were chirping.  Folks were strolling down the Mall.  People still have their doctors.

From this day forward, all of the cynics, all the naysayers -- they’re going to have to confront the reality of what this reform is and what it isn’t.  They’ll have to finally acknowledge this isn’t a government takeover of our health care system.  They’ll see that if Americans like their doctor, they’ll be keeping their doctor.  You like your plan?  You’ll be keeping your plan.  No one is taking that away from you.  Three months from now, six months from now you’re going to look around.  You’re going to be sitting in a doctor’s office reading through the old People magazines.  (Laughter.)  And you’ll say, hey, this is the same doctor, same plan.  It wasn’t Armageddon.

What this reform does is build on the system of private health insurance that we already have.  So does that mean that it’s going to solve every health care problem that we have?  No.  But it finally tells -- oops, it looks like somebody may have fainted.  That happens sometimes in the crowd.  Just give him some space.  If the medics can make sure to check on them, in the meantime just make sure that they’ve got some air.  And if anybody has some water down there, that’d be great.  They’ll be all right.

But here’s what the bill does.  It finally tells the insurance companies that in exchange for all the new customers they’re about to get, they’ve got to start playing by a new set of rules that treats everybody honestly and treats everybody fairly.  (Applause.)  The days of the insurance industry running roughshod over the American people are over.

So if you already -- if you already have insurance, this reform will make it more secure and more affordable.  If you can’t afford insurance right now or if you’ve been denied coverage -- and I'll bet there are some folks here who don't have insurance or can’t afford it or have been denied coverage -- you’re going to finally be able to get it.  Costs will come down for families, and businesses, and the federal government, reducing our deficit by more than $1 trillion over the next two decades.  That’s what reform is going to do.  (Applause.)

Now, it’s going to take about four years to implement this entire plan -- because we’ve got to do it responsibly and we need to do it right.  So I just want to be clear:  that means that health care costs won’t go down overnight; not all the changes are going to be in place; there are still going to be aspects of the health care system that are very frustrating over the next several years.

But we have built into law all sorts of measures that in the years to come, health care inflation, which has been rising about three times as fast as people’s wages, is finally going to start slowing down.  We’ll start reducing the waste in the system, from unnecessary tests to unwarranted insurance subsidies.  So that over time, Americans are going to save money.

And meanwhile, there are a set of reforms that begin to take into effect this year, so I want to talk about this.  This year, millions of small business owners will be eligible for tax credits that will help them cover the cost of insurance for their employees.  (Applause.)  This year, millions of small businesses will benefit.

So let me talk to you about what this means for a business like your own Prairie Lights Bookstore downtown.  (Applause.)  This is a small business that’s been offering coverage to their full-time employees for the last 20 years.  Last year their premiums went up 35 percent, which made it a lot harder for them to offer the same coverage.  On Tuesday, I was joined at the bill signing by Ryan Smith, who runs a small business with five employees.  His premiums are going up too.  He’s worried about having to stop offering health insurance to his workers.

So starting now, small business owners like Ryan and the folks at Prairie Light, they’re going to have the security of knowing that they’ll qualify for a tax credit that covers up to 35 percent of their employees’ health insurance.  (Applause.)  Starting today, starting today, small business owners -- (applause) -- so starting today, small business owners can sit down at the end of the week, look at their expenses, and they can begin calculating how much money they’re going to save.  And maybe they can even use those savings to not only provide insurance but also create jobs.  This health care tax credit is pro-jobs, it is pro-business, and it starts this year, and it’s starting because of you.  (Applause.)

Starting this year, tens of thousands of uninsured Americans with a preexisting condition and parents whose children have a preexisting condition will finally be able to purchase the coverage they need.  (Applause.)

On Tuesday, right after I signed the bill, I met David Gallagher, whose daughter Lauren had written me a letter last year.  And when Lauren’s mom lost her job, the entire family lost their health insurance.  And when they tried to get new insurance, David was denied coverage because he once had a complication-free hernia surgery.

So Lauren’s been worried sick about what would happen if her father became ill or injured.  But now, because of this reform, David Gallagher can finally have access to health insurance again.  That starts this year -- because of you and the work that you did.  (Applause.)

This year, insurance companies will no longer be able to drop people’s coverage when they get sick, or place lifetime limits or restrictive annual limits on the amount of care they can receive.  (Applause.)

This year, all new insurance plans will be required to offer free preventive care.  And by the way, for all the students who are here today -- (applause) -- starting this year, if you don’t have insurance or if you’re about to graduate and you’re not sure what your next job is going to be or there’s a little gap between getting that job with insurance, all new plans and some current ones will allow you to stay on your parents’ insurance policy until you’re 26 years old, starting this year.  (Applause.)  Because as you start your lives and your careers, the last thing you should worry about is whether you go broke just because you get sick.

This year, for the seniors who are in the audience, if you fall in the coverage gap known as the doughnut hole, you’re going to receive $250 to help pay for prescriptions, which will be the first step toward closing that doughnut hole, that gap completely.  (Applause.)  And I want seniors to know that despite what some have said, these reforms will not cut your guaranteed benefits.  In fact, under this law, Americans on Medicare will receive free preventive care without co-payments and deductibles.

Darlyne Neff is here today.  She’s a breast cancer survivor.  She has fought her heart out for reform over the last few years.  Today, the preventive care she needs will finally be covered without charge.  That’s what this reform will do.  That’s what’s happening because of you.  (Applause.)

And once this reform is implemented, then health insurance exchanges are going to be created.  This is the core -- the core aspect of this bill that is going to be so important to Americans who are looking for coverage.  Basically, we set up a competitive marketplace where people without insurance, small businesses, people who were having to pay through the teeth because they’re just buying insurance on their own, maybe you’re self-employed -- you’re finally going to be able to purchase quality, affordable, health insurance because you’re going to be part of a big pool -- by the way, with members of Congress.  So you will be able to get the same good deal that they’re getting, because if you’re paying their salary, you should have health insurance that’s at least as good as theirs.  (Applause.)

That’s what’s going to happen in the next few years.  And when this exchange is up and running, millions of people are going to be getting tax breaks to help them afford coverage.  And the credits add up to the largest middle class tax cut for health care in history.

This is a -- that’s the basic aspects of reform.

AUDIENCE MEMBER:  What about the public option?

THE PRESIDENT:  That’s not in it.

AUDIENCE MEMBER:  Why not?

THE PRESIDENT:  Because we couldn’t get it through Congress, that’s why.  So they -- let’s -- there’s no need to shout, young man, no need to shout.

Thirty-two people -- 32 million people are going to have health insurance because of this legislation.  That’s what this work is about.  (Applause.)  So that’s what’s going to happen.

Now, I want to just make this point.  This legislation is not perfect, as you just heard.  (Laughter.)  This young man is dissatisfied with an aspect of it, which is fine.  I mean, that’s part of what democracy is about.  But what this is, is a historic step to enshrine the principle that everybody gets health care coverage in this country, every single person.  (Applause.)

And it’s absolutely true -- it’s absolutely true this is a middle-of-the-road bill.  This isn’t single-payer, which some people wanted.  It’s also not what the Republicans were looking for, which was basically to deregulate the insurance industry, arguing that somehow this would cut down costs -- something that defies the experience of everybody who’s dealt with an insurance company out there.  (Laughter.)

So, yes, this is a common-sense bill.  It doesn’t do everything that everybody wants, but it moves us in the direction of universal health care coverage in this country and that's why everybody here fought so hard for it.  (Applause.)

This is the reform that some folks in Washington are still hollering about, still shouting about.  Now that they passed it -- now that we passed it, they’re already promising to repeal it.  They’re actually going to run on a platform of repeal in November.  You’ve been hearing that.  And my attitude is:  Go for it.  (Applause.)

If these congressmen in Washington want to come here in Iowa and tell small business owners that they plan to take away their tax credits and essentially raise their taxes, be my guest.  If they want to look Lauren Gallagher in the eye and tell her they plan to take away her father’s health insurance, that’s their right.  If they want to make Darlyne Neff pay more money for her check-ups, her mammograms, they can run on that platform.  If this young man out here thinks this is a bad bill, he can run to repeal it.  If they want to have that fight, we can have it.  Because I don’t believe that the American people are going to put the insurance industry back in the driver’s seat.  We’ve already been there.  We're not going back.  This country is moving forward.  (Applause.)

The road to this victory, Iowa, has been long, it has been difficult.  It’s a struggle that a lot of brave Americans have waged for years.  For others, like our friend Ted Kennedy, it’s a struggle that was waged for nearly a lifetime.  (Applause.)

But what this struggle has taught us -- about ourselves and about this country -- is so much bigger than any one issue, because it’s reminded us what so many of us learned all those months ago on a cold January night here in Iowa, and that’s that change is never easy, but it’s always possible.  (Applause.)  It comes not from the halls of power, but from the hearts of our people.  Amid setbacks, it requires perseverance.  Amid calls for delay, it requires the fierce urgency of now.  In the face of unrelenting cynicism, it requires unyielding hope.

And when I came here three years ago, I told the story of when Lyndon Johnson stood with Harry Truman and signed Medicare into law.  That wasn’t perfect either.  I’m sure there was somebody who was dissatisfied with it at the time.  And as he looked out over the crowd in Independence, Missouri, that day, he said, “History shapes men, but it is a necessary faith of leadership that men can shape history.”

What this generation has proven today is that we still have the power to shape history.  (Applause.)  In the United States of America, it is still a necessary faith that our destiny is written by us, not for us.  Our future is what we make it.  Our future is what we make it.  Look, this is not the end of difficult times for America.  From creating jobs to reducing deficits to making sure every child has a decent education, we still face enormous challenges in this country.  And as we meet those challenges, we’re going to face more resistance.  We’re going to face more doubt, we’re going to face more cynicism.  We’re going to hear more voices who will warn us that we’re reaching too far, that we’re going too fast; who are going to tell us that we can’t, who are going to just make wild accusations about what we’re trying to do.

And when that happens, we’ve got to remember the promise that we have already fulfilled, and the people who fulfilled it, and the generations before us who made it possible.  We’re going to have to respond with the creed that continues to define the character of this country we love, and it’s my favorite memory of Iowa, that creed that says:  Yes, we can.  (Applause.)

Iowa -- yes, we did, because of you.  (Applause.)  And it’s because of you that we are going to keep on going to make sure that we fulfill every promise to every child in this country for a brighter future.  Thank you.  God bless you.  And God bless the United States of America.  (Applause.)

END
1:37 P.M. CDT

ENSURING ENFORCEMENT AND IMPLEMENTATION OF ABORTION RESTRICTIONS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT

By the authority vested in me as President by the Constitution and the laws of the United States of America, including the "Patient Protection and Affordable Care Act" (Public Law 111-148), I hereby order as follows:

Section. 1. Policy. Following the recent enactment of the Patient Protection and Affordable Care Act (the "Act"), it is necessary to establish an adequate enforcement mechanism to ensure that Federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), consistent with a longstanding Federal statutory restriction that is commonly known as the Hyde Amendment. The purpose of this order is to establish a comprehensive, Government-wide set of policies and procedures to achieve this goal and to make certain that all relevant actors -- Federal officials, State officials (including insurance regulators) and health care providers -- are aware of their responsibilities, new and old.

The Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly created health insurance exchanges. Under the Act, longstanding Federal laws to protect conscience (such as the Church Amendment, 42 U.S.C. 300a-7, and the Weldon Amendment, section 508(d)(1) of Public Law 111-8) remain intact and new protections prohibit discrimination against health care facilities and health care providers because of an unwillingness to provide, pay for, provide coverage of, or refer for abortions.

Numerous executive agencies have a role in ensuring that these restrictions are enforced, including the Department of Health and Human Services (HHS), the Office of Management and Budget (OMB), and the Office of Personnel Management.

Sec. 2. Strict Compliance with Prohibitions on Abortion Funding in Health Insurance Exchanges. The Act specifically prohibits the use of tax credits and cost-sharing reduction payments to pay for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered) in the health insurance exchanges that will be operational in 2014. The Act also imposes strict payment and accounting requirements to ensure that Federal funds are not used for abortion services in exchange plans (except in cases of rape or incest, or when the life of the woman would be endangered) and requires State health insurance commissioners to ensure that exchange plan funds are segregated by insurance companies in accordance with generally accepted accounting principles, OMB funds management circulars, and accounting guidance provided by the Government Accountability Office.

I hereby direct the Director of the OMB and the Secretary of HHS to develop, within 180 days of the date of this order, a model set of segregation guidelines for State health insurance commissioners to use when determining whether exchange plans are complying with the Act's segregation requirements, established in section 1303 of the Act, for enrollees receiving Federal financial assistance. The guidelines shall also offer technical information that States should follow to conduct independent regular audits of insurance companies that participate in the health insurance exchanges. In developing these model guidelines, the Director of the OMB and the Secretary of HHS shall consult with executive agencies and offices that have relevant expertise in accounting principles, including, but not limited to, the Department of the Treasury, and with the Government Accountability Office. Upon completion of those model guidelines, the Secretary of HHS should promptly initiate a rulemaking to issue regulations, which will have the force of law, to interpret the Act's segregation requirements, and shall provide guidance to State health insurance commissioners on how to comply with the model guidelines.

Sec. 3. Community Health Center Program. The Act establishes a new Community Health Center (CHC) Fund within HHS, which provides additional Federal funds for the community health center program. Existing law prohibits these centers from using Federal funds to provide abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), as a result of both the Hyde Amendment and longstanding regulations containing the Hyde language. Under the Act, the Hyde language shall apply to the authorization and appropriations of funds for Community Health Centers under section 10503 and all other relevant provisions. I hereby direct the Secretary of HHS to ensure that program administrators and recipients of Federal funds are aware of and comply with the limitations on abortion services imposed on CHCs by existing law. Such actions should include, but are not limited to, updating Grant Policy Statements that accompany CHC grants and issuing new interpretive rules.

Sec. 4. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect: (i) authority granted by law or Presidential directive to an agency, or the head thereof; or (ii) functions of the Director of the OMB relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees or agents, or any other person.

BARACK OBAMA

THE WHITE HOUSE,
March 24, 2010.

http://www.whitehouse.gov/sites/default/files/2010patientprotect-eo-rel.pdf

En el siguiente enlace pueden encontrar la foto del Presidente firmando el decreto ejecutivo: http://www.flickr.com/photos/whitehouse/4460769992/ 

THE VICE PRESIDENT:  Thank you all.  (Applause.) 

AUDIENCE:  Yes, we can!  Yes, we can!  Yes, we can!

THE VICE PRESIDENT:  Yes, he did.  (Applause.)  Thank you all for being here, ladies and gentlemen.  Please be seated. 

Ladies and gentlemen, to state the obvious, this is truly a historic day.  But as all of you know, history is not merely what’s printed in our textbooks.  It doesn’t begin or end with a stroke of a pen.  History is made.  History is made when men and women decide that there’s a greater risk in accepting the situation we cannot bear than in steeling our spines and embracing the promise of change.  History is made when a leader’s passion is matched with his principle in service of his country.

Mr. President, your passion to make the lives of ordinary Americans better has been on display.  And the principles that guided your public service, beginning when you were a community organizer, have led this nation to this moment.  Mr. President, 30 minutes ago, by the stroke of your pen, you began the process of making life better for tens of millions of Americans today and for evermore.  (Applause.) 

For much too long, for much too long, Americans have been denied what every human being is entitled to -- decent, affordable health care.  Starting with Teddy Roosevelt straight through to you, Mr. President, everyone else tried.  They were great men, they gave it their best, but they came up short.  But you succeeded, Mr. President, and we owe you for that.  (Applause.)

As I said just before the President signed the health care bill, I quoted Virgil, the classic Greek poet, who once said, “The greatest wealth is health.”  The greatest wealth is health.  Mr. President, you’ve made us a nobler and wealthier nation by providing for the health of your fellow citizens.

Ladies and gentlemen, the President of the United States of America, Barack Obama.  (Applause.)

THE PRESIDENT:  Thank you, everybody.  Thank you.  (Applause.)  Thank you, everybody.  Please have a seat. 

We wanted to do this twice -- (laughter) -- because there are so many people we have to thank.  And as I look around the room, we've got leaders of labor who helped to make this happen.  We've got ordinary folks who knocked on doors and made phone calls at the last minute to get this thing over the top.  My extraordinary members of my Cabinet -- we've still got some additional members of Congress who helped lead the charge on this.  There’s my staff, who I see are still here.  (Laughter.)  At any given moment I thought they were going to quit -- (laughter) -- but they just stuck it out with me. 

So the main purpose here is to say thank you, and thank you on behalf of the American people.

After a century of striving, after a year of debate, after a historic vote, health care reform is no longer an unmet promise.  It is the law of the land.  It is the law of the land.  (Applause.) 

And although it may be my signature that’s affixed to the bottom of this bill, it was your work, your commitment, your unyielding hope that made this victory possible.  When the special interests deployed an army of lobbyists, an onslaught of negative ads, to preserve the status quo, you didn’t give up.  You hit the phones and you took to the streets.  You mobilized and you organized.  You turned up the pressure and you kept up the fight.

When the pundits were obsessing over who was up and who was down, you never lost sight of what was right and what was wrong.  You knew this wasn’t about the fortunes of a party -- this was about the future of our country.  (Applause.) 

And when the opposition said this just wasn’t the right time, you didn’t want to wait another year, or another decade, or another generation for reform.  You felt the fierce urgency of now.

You met the lies with truth.  You met cynicism with conviction.  Most of all, you met fear with a force that’s a lot more powerful -- and that is faith in America.  You met it with hope.  (Applause.) 

Despite decades in which Washington failed to tackle our toughest challenges, despite the smallness of so much of what passes for politics these days, despite those who said that progress was impossible, you made people believe that people who love this country can still change it. 

So this victory is not mine -- it is your victory.  It’s a victory for the United States of America.  (Applause.)

For two years on the campaign trail, and for the past year as we’ve worked to reform our system of health insurance, it’s been folks like you who have propelled this movement and kept us fixed on what was at stake in this fight.  And rarely has a day gone by that I haven’t heard from somebody personally -- whether in a letter, or an email, or at a town hall -- who’s reminded me of why it was so important that we not give up; who reminded me why we could not quit.

I heard from Ryan Smith, who’s here today, and runs a small business with five employees.  He is trying to do the right thing, paying for half of the cost of coverage for his workers.  But as his premiums keep on going up and up and up, he’s worried he’s going to have to stop offering health care for his people.  But because of this bill he is now going to be getting tax credits that allow him to do what he knows is the right thing to do -- and that's going to be true for millions of employers all across America.  (Applause.)

I heard the story of 11-year-old Marcelas Owens, who’s right here -- looking sharp -- (applause.)  He and I made sure to coordinate our ties today.  (Laughter.)  Yes, it looks good.  (Laughter.)

Marcelas is a wonderful young man, and he lost his mom to illness.  And she didn’t have insurance and couldn’t afford the care that she needed.  So in her memory, Marcelas, 11 years old, has told her story across America so that no other children have to go through what his family has experienced.  (Applause.)  That's why we don't quit.  (Applause.)

I heard from folks like Natoma Canfield, who had to give up her health coverage after her rates were jacked up by more than 40 percent.  She was terrified that an illness would mean she’d lose the house that her parent built, but she also knew that if she was burdened by these huge premiums, that she wouldn’t be able to pay the mortgage.  So she finally decided not to -- not to keep her health insurance.  And she’s now lying in a hospital bed, as we speak, faced with just such an illness, and she’s praying that she can somehow afford to get well.  And her sister Connie is here today.  (Applause.)  And it’s because of Natoma’s family that we could not quit.  (Applause.)

I’ve met people like Ashley Baia, who worked for my campaign.  Where’s Ashley?  She’s around here somewhere.  I know she is.  There she is, right in front.  She just doesn’t like waving.  (Laughter.)  Ashley decided to get involved with our campaign a couple of years ago because her own mother lost her job, and with it, her health insurance when she got sick.  And they had to file bankruptcy.  And so Ashley worked tirelessly, not to get me elected, but to solve a problem that millions of families across the country were facing.

Each of these Americans made their voices heard.  It’s because of them, and so many others, so many of you, that real, meaningful change is coming to the United States of America.  (Applause.)  It is because of you that we did not quit.  It’s because of you that Congress did not quit.  It’s because of you that I did not quit.  It’s because of you.  (Applause.) 

Now, let me tell you what change looks like -- because those fighting change are still out there, still making a lot of noise -- (laughter) -- about what this reform means.  So I want the American people to understand it.  And look it up for yourself.  Go on our Web site, whitehouse.gov, or go to any credible news outlet’s Web site, and look in terms of what reform will mean for you.  (Laughter.)

I said this once or twice, but it bears repeating:  If you like your current insurance, you will keep your current insurance.  No government takeover; nobody is changing what you’ve got if you’re happy with it.  If you like your doctor, you will be able to keep your doctor.  In fact, more people will keep their doctors because your coverage will be more secure and more stable than it was before I signed this legislation.

And now that this legislation is passed, you don’t have to take my word for it.  You’ll be able to see it in your own lives.  I heard one of the Republican leaders say this was going to be Armageddon.  Well, two months from now, six months from now, you can check it out.  We’ll look around –- (laughter) -- and we’ll see.  (Applause.)  You don’t have to take my word for it.  (Applause.)

So what works in our system won’t change.  And a lot of people are happy with the health care that they’ve got and that won’t change because of this legislation.  Here’s what will change, and here’s what will change right away:

This year, we’ll start offering tax credits to about 4 million small businesses to help them cover the cost of coverage.  And that means that folks like Ryan will immediately get a tax break so that he can better afford the coverage he’s already providing for his employees.  And who knows, because of that tax break, he may decide to hire a couple more folks in his small business -- because of this legislation.  (Applause.) 

This year, tens of thousands of uninsured Americans with a preexisting condition and parents whose children have a preexisting condition will finally be able to purchase the coverage they need.  And that means folks like Natoma Canfield will have access to affordable insurance.  That happens this year.  (Applause.) 

This year, insurance companies will no longer be able to drop people’s coverage when they get sick, or place lifetime limits or restrictive annual limits on the amount of care they can receive.  This year, all new insurance plans will be required to offer free preventive care.  And this year, young adults will be able to stay on their parents’ policies until they’re 26 years old.  That all happens this year.  (Applause.)

This year, seniors who fall in the coverage gap known as the doughnut hole will get some help to help pay for prescription drugs.  And I want seniors to know, despite what some have said, these reforms will not cut your guaranteed benefits.  Let me repeat that:  They will not cut your guaranteed benefits.  Period.  I’d be wary of anybody who claimed otherwise.

So these are the reforms that take effect right away.  These reforms won’t give the government more control over your health care.  They certainly won’t give the insurance companies more control over your health care.  (Applause.)  These reforms give you more control over your health care.  And that’s only the beginning.  (Applause.) 

That’s only the beginning.  After more than a decade, we finally renewed the Indian Health Care Improvement Act.  (Applause.)  And the other changes I’m signing into law will take several years to implement fully, but that’s because this is a difficult, complex issue and we want to get it right.

One of these reforms is the creation of a health insurance exchange.  This is one of the most important reforms -- and by the way, originally, I should point out, a Republican idea.  Imagine that.  (Laughter.) 

The idea is, is that right now there are a lot of people out there buying health insurance on their own, or small businesses buying health insurance on their own.  They don’t work for a big company, they’re not part of a big pool, so they have no leverage; they’ve got no bargaining power with insurance companies.  But now what we’re going to do is create exchanges all across the country where uninsured people -- small businesses -- they’re going to be able to purchase affordable, quality insurance.  They will be part of a big pool, just like federal employees are part of a big pool.  They’ll have the same choice of private health insurance that members of Congress get for themselves.  That’s going to happen as a consequence of this legislation.  (Applause.) 

And when this exchange is up and running, not only because of better bargaining power will they see their premiums reduced, will people get a better deal, but millions of people who still can’t afford it are going to get tax breaks so they can afford coverage.  And this represents the largest middle-class tax cut for health care in our history.  (Applause.)  And it’s going to mean that millions of people can get health care that don’t have it currently.

Now, for those of us who fought so hard for these reforms, and believe in them so deeply, I have to remind you our job is not finished.  We’re going to have to see to it that these reforms are administered fairly and responsibly.  And this includes rooting out waste and fraud and abuse in the system.  That’s how we’ll extend the life of Medicare and bring down health care costs for families and businesses and governments.  And in fact, it is through these reforms that we achieve the biggest reduction in our long-term deficits since the Balanced Budget Act of the 1990s. 

So for all those folks out there who are talking about being fiscal hawks and didn’t do much when they were in power -- (applause) -- let’s just remind them that according to the Congressional Budget Office, this represents over a trillion dollars of deficit reduction that is being done in a smart way.

And for those who’ve been suspicious of reform -- and there are a lot of wonderful folks out there who, with all the noise, got concerned -- because of the misinformation that has marred this debate, I just repeat, don’t take my word for it.  Go to our Web site, whitehouse.gov; go to the Web sites of major news outlets out there; find out how reform will affect you.  And I’m confident that you will like what you see -- a common-sense approach that maintains the private insurance system but makes it work for everybody; makes it work not just for the insurance companies, but makes it work for you.  

So that’s what health reform is all about.  Now, as long a road as this has been, we all know our journey is far from over.  There’s still the work to do to rebuild this economy.  There’s still work to do to spur on hiring.  There’s work to do to improve our schools and make sure every child has a decent education.  There’s still work to do to reduce our dependence on foreign oil.  There’s more work to do to provide greater economic security to a middle class that has been struggling for a decade. 

So this victory does not erase the many serious challenges we face as a nation.  Those challenges have been allowed to linger for years, even decades, and we’re not going to solve them all overnight. 

But as we tackle all these other challenges that we face, as we continue on this journey, we can take our next steps with new confidence, with a new wind at our backs -- because we know it’s still possible to do big things in America -- (applause) -- because we know it’s still possible to rise above the skepticism, to rise above the cynicism, to rise above the fear; because we know it’s still possible to fulfill our duty to one another and to future generations.  (Applause.)

So, yes, this has been a difficult two years.  There will be difficult days ahead.  But let us always remember the lesson of this day -- and the lesson of history -- that we, as a people, do not shrink from a challenge.  We overcome it.  (Applause.)  We don’t shrink from our responsibilities.  We embrace it.  We don’t fear the future.  We shape the future.  That’s what we do.  That’s who we are.  That makes us the United States of America.  (Applause.)

God bless you.  And God bless the United States of America.  Thank you.  (Applause.)

END
1:01 P.M. EDT