Kathleen Sebelius' Transcript from NIHB conference


The following is Secretary of the Department of Health and Human Services Kathleen Sebelius’ transcript from the National Indian Health Board Consumer Conference held Sept. 15, 2009 in Washington D.C.:

Reno Keoni Franklin, chairman, National Indian Health Board: Now comes the fun stuff. I get to introduce the secretary of the Department of Health and Human Services, Kathleen Sebelius, who was sworn in as the 21st secretary, Tuesday, April 29th, and promptly came to meet with tribes.

Her first day in, she came to meet with the tribes. We were having our annual budget consultation inside of a very beautiful building. And that was a beautiful action to see a secretary do – immediately put us up and come in, introduce herself, begin to get to know us, begin to build that relationship on her first day.

That doesn’t happen all the time. You know, we need to support that. And I respect your actions by doing that, and I appreciate it.

Secretary Sebelius has over 20 years of experience in state government, has been a leader on health care issues for over a decade. She was first elected governor of Kansas in 2003 and was re-elected in 2006. Throughout her tenures, Secretary Sebelius was lauded for her record of bipartisan accomplishment.

She worked tirelessly to grow the state’s economy and to create jobs, to ensure that every Kansas child received a quality education and to improve access, equality and affordable health care.

As governor, Secretary Sebelius expanded Kansas newborn screenings, put a renewed emphasis on childhood immunization and increased eligibility for children’s health coverage. More than 59,000 additional children were enrolled in health coverage during her time in office – 59,000.

Sebelius also worked closely with Kansas first responders and law enforcement to prepare for national disasters and other emergencies. In 2005, TIME Magazine named her one of the nation’s top five governors.

Prior to her tenure as governor, Secretary Sebelius spent eight years serving as Kansas state insurance commissioner. In that capacity, Sebelius turned her department into a steadfast advocate for Kansas consumers and helped senior citizens save more than $7 million on prescription drugs. Think about how something like that could help your clinics and your hospitals.

She also won praise for blocking the sale of Kansas Blue Cross Blue Shield by an out-of-state, for-profit health care conglomerate, and for her role in drafting a proposed national bill of rights for patients.

Previously, she was a member of the Kansas House of Representatives, 1986 to 1994. Married to husband, Gary, a federal magistrate judge for 34 years, they have two sons, Ned and John.

And it’s my pleasure to introduce Secretary Sebelius.


Kathleen Sebelius, secretary of Health and Human Services, U.S. Department of Health and Human Services: Thank you.


Thank you very much.


Thank you.

Well, good morning, everyone. And thank you so much, Chairman Franklin, for that very nice introduction. And thank you, more importantly, for the leadership that you are providing to the National Indian Health Board.

As the chairman has told you, day one in the office happened to be the day that representatives of various tribes were in the Department of Health and Human Services to engage in the annual budget consultation. And I was pleased to have a chance to come and introduce myself to the leaders, and make it very clear that not only I as the secretary of Health and Human Services, but on behalf of the president, we very much want to work with all of you to not only improve what’s happening throughout tribal country, but really improve the lives of all Americans.

What I like to tell people is that, in the Department of Health and Human Services, health and human services are back. We really do embrace and believe that that’s a critical mission.


And we are very committed to working with you, to listening to you, to collaborating with you, on providing the best health care and highest quality of life to the American Indian and Alaskan Native people.

I think it’s critical – after, frankly, years of neglect – that we strengthen the government-to-government relationships.


As your chairman said, I was governor in a state where we had four Native tribes, and believe very strongly in government-to-government consultation and relationship, and did that throughout my term as governor. So, this is not a new phenomenon to me. It’s something that I have not only believed in, but acted on for the time I was governor.

But I want to tell you, I’m not alone in the department in feeling this way. My chief of staff, Laura Petrou, worked with South Dakota tribes for years in Senator Daschle’s office. She was in that office for almost 30 years, and had a lot of relationships with tribes around the country.

Paul Dioguardi, who is here today, is our director of intergovernmental affairs, and has done really from, again, day one, a great job coordinating our work with tribal governments.

And I am so pleased to have Dr. Yvette Roubideaux as the new head of the Indian Health Services.


As you know, she not only leads the Indian Health Services now, but she began as a patient in the Indian Health Services. So, she knows the system very well – as a patient, as a practitioner and, now, as the leader. She told me that yesterday she had some very productive conversations in the town hall about ways to improve relationships within the Department of Health and Human Services, and also some of the internal workings in the Indian Health Service.

So, I look forward to getting that feedback from Dr. Roubideaux after your meetings over the next three days, because we want to make sure that your ideas and input are reflected in everything from what our budget proposals are moving forward, to the legislative proposals we put forward, to the way we look at work within our regional offices. All of those facets of our department really can have a great impact.

I wanted to talk this morning a little bit about two topics which, frankly, have kind of dominated my time and attention since I arrived about four-and-a-half months ago. And those are health reform and the H1N1 virus.

And I think it’s very appropriate that the board is here in Washington at this historic moment in time. And I hope there’ll be an opportunity for all of you to reach out to the members of Congress and the Senate, because there isn’t any more important time in the health reform dialogue and debate than right now, to make it clear that we expect people to move ahead.

The debate over health insurance reform is entering its final phase. And hopefully, most of you got a chance to listen to the president’s speech on Wednesday night. And if not, I’d highly recommend that you might find it online, because I think he did a great job making it very clear, not only why this initiative needs to move forward, but what exactly he is proposing.

He said, if you have health insurance that works for you and your family, you’ll keep it. But rules are going to change once and for all for insurance companies.

As your chairman said, I spent eight years as insurance commissioner. And during that time, one of the main jobs I took very seriously was to negotiate with companies over and over and over again, to try and get access to the benefits that people had already paid for. So, if you want to know who stands between a patient and their doctor, often it’s an insurance company right now …


… who’s denying treatments, denying prescriptions, saying you can’t go to the hospital, you can’t stay in the hospital.

One of my more horrifying experiences was early in that tenure as insurance commissioner. We began to get reports of women who were giving birth, but then ending up re-hospitalized. And what we found is that insurance companies had decided that they would save some dollars by limiting the amount of time new moms spent in the hospital, and actually were doing it by hours.

So, depending on what time your baby was born, you were basically given about 18 hours. It might be an overnight, if you had the baby in the afternoon. But if you had the baby in the middle of the night, you were often out the door the next day.

Now, for an experienced mom with lots of help and support, that may be fine, because being in the hospital isn’t the most restful or pleasant place to be. But if you’re a new mom without a lot of help and support, and if you’ve had a difficult pregnancy, or a difficult labor and delivery, that’s a very dangerous thing to do.

And what we saw is people being re-admitted, babies with jaundice because they weren’t nursing properly, people being re-admitted, because where their health situation they were in was not taken care of.

So, in the effort to save money, what insurance companies had done is actually incur far greater costs, because the re-admission often was much lengthier than the stay would have been in the first place, just letting people rest and get comfortable and be ready to go home.

We had to pass a law in Kansas saying, you know, no more drive-by deliveries. You’ve got to, if someone has come into the hospital to have a baby, they get to stay in the hospital …


… and make sure they’re well and healthy to exit. But that was just a vivid example to me of the kind of craziness that was going on.

We have in this country right now, even if insurance is affordable, we have too many Americans who are choosing not to buy coverage, feeling that they really don’t need it, or they won’t have it until they may get sick. And often, younger, healthier folks are staying out of the insurance market.

So, one of the things that the president has suggested that he will support is, with the opportunity for all Americans to have affordable health coverage, a mandate that says individuals must purchase health insurance to make sure that we have a risk pool that will balance.

But I want to make it very clear, because this wasn’t spelled out on Wednesday night, that the administration strongly believes that that individual mandate and the subsequent penalties don’t apply to American Indians or Alaskan Natives …


… that you have already purchased health insurance …


… that that is already a part of the agreement that we’ve made.


So, while the goal of reform is to expand access to quality, affordable insurance, we know that you can have the best access in the world, but it doesn’t really matter unless you have high quality care. Today, there are way too many Americans, including many of you in Indian country, who can’t see a primary care provider, because there is a shortage in your communities.

The latest estimate that I’ve seen is that there are more than 100 primary clinical vacancies in 20 different Indian health service facilities. That’s not good news.

Part of the Recovery Act that the president signed and that Congress passed was an increase in the workforce, because we know one of the shortages in this country is for doctors, nurse practitioners, mental health professionals, dental clinicians. So, that pipeline is already being filled.

And part of the effort is to also ensure – and I was with one of our department leaders the other day when we announced another $50 million grant, specifically aimed at encouraging a diverse workforce. So, we’re really reaching out to populations that not only are underserved in terms of where we’d like doctors eventually to locate, but we want to reach out to students. And certainly, the tribal members are a great audience for that.

We would encourage people to look at the opportunity for scholarships that are now available for nurses, nurse practitioners, doctors, mental health clinicians, because we think, in the long run, those most likely to be very interested in working with home communities are likely to come from those home communities.

So, the pipeline is going to encourage not only placement at the end of the study time, but also trying to reach out to folks saying, think about a health profession. This is not only a wonderful way to serve your community, but it’s a great opportunity, and there is money available.

So, we know access is important. We know clinicians are important. So is lowering costs.

And one of the best ways to lower cost is not the example I just gave you for, you know, cutting benefits or denying people care, but it’s really looking at what’s happening to the health of our nation. And it isn’t very good.

We spend now, twice as much as any nation on earth per capita for health care – twice as much. And yet, we live sicker and die younger than any developed country in the world. Again, not a very good scenario. So, the amount of money we spend is not yielding great health results.

What we know is that way too many Americans end up in a situation where they suffer from chronic diseases. Chronic diseases account for about 70 percent of the deaths every year, and 75 percent of our health care costs are focused on chronic diseases.

Obesity alone costs our health system about $150 billion a year. That’s more money – almost twice as much money – as all the cancers put together. Obesity, twice as much as every cancer that Americans suffer from. So, focusing on how we end up with a healthier and a healthier nation with more prevention efforts is clearly part of the overall health reform.

Now, nobody knows these statistics better than American Indians and Alaskan Natives, because the mortality rate for Native people is six times higher than it is for the rest of America. The morbidity rate for diabetes is three times higher. So, as bad as those earlier numbers sounded, that was the national average. The numbers in Indian country are far scarier.

And the cheapest and most effective way of dealing with a lot of these health problems is preventing them from becoming problems in the first place.


Bless you.

But currently, in our health care system, we spend a lot of time and money focused on sickness, and not nearly enough on health and wellness, on prevention. We spend thousands of dollars treating a heart attack, but almost nothing on trying to take steps to prevent that heart attack in the first place.

So, health insurance reform would begin that critical transformation. It would eliminate all the extra payments right now in place for preventive care, to encourage more folks to take advantage of early screenings and childhood checkups and immunizations. We think that eliminating co-pays for all of those health treatments would actually be a big step in the right direction.

What I know is that nearly half of American Indian and Alaskan Native women between the ages of 52 and 64 haven’t received a mammogram in the last two years. That’s not a good place to be. We need to encourage yearly screenings.

We know that breast cancer now is curable. There are lots of people who live for a long time, having had treatment. But it’s curable if you find it early and if you identify it early. So, we need to make sure that we take advantage of that.

In the next couple of months, we’ll also be announcing a new opportunity, $650 million in grants from the Recovery Act that will fund a variety of local prevention initiatives. We want to invest in some community programs around the country, to actually do some measurable programming to see what actually works.

Right now, a lot of the prevention efforts are anecdotal. Nobody’s ever really invested and said, OK, these three strategies really change people’s behavior, change people’s minds, encourage folks to live healthier lifestyles.

So, we want to have these projects – and I told your executive board today, I’m very hopeful that some of the tribal communities will apply when the grants become available and will become part of these projects.

So, health insurance reform is about security and stability for those Americans who already have insurance. So, we change the insurance rules and we bring down the costs, and we make it clear, if you lose your job or if you change your job, or you move to a different state, or if you retire early, you will have access to affordable health coverage.

For the 46, 47 million Americans without coverage at all, or the 25 to 30 million who have under-insurance – they may be covered for some things, but not nearly the kind of health risks that their families take each and every day – it will mean, finally, in bigger pools, affordable coverage.

And then, as I said, not only a far different workforce, looking at primary care as the first step, making sure that we have access to medical help. But also, investing for the first time ever in the history of our country in health and wellness.

So, I hope that you all will lend your voices to this critical debate, to make sure that Congress continues to move ahead.

In addition to meeting with the tribal leaders the first day I was in the Department of Health and Human Services, I was also greeted with the new H1N1 virus, which at that point, in late April of this year, was beginning to explode around the country. And frankly, we really didn’t know at that point what we were facing. We knew it was a new virus. We didn’t know how lethal it would be.

In fact, in Mexico, some very ominous reports were coming out, what seemed to be a large number of deaths with a relatively small number of cases, which is why you saw in the late spring and early summer, schools closing and some fairly drastic activities going on, because it really wasn’t very certain if people would really die in much larger numbers from getting this flu, if we’d be back in the situation we were looking at in 1918 with a pandemic that spread rapidly. And in those days, we had 500,000 Americans die from the flu epidemic, which was fairly mild in the spring, came back in the fall, and was a pretty terrifying scenario.

We’ve learned a lot since then. And here’s what we know, that H1N1 is presenting much more like seasonal flu. That’s good news, but serious.

Seasonal flu every year has about 200,000 people who are hospitalized, and about 36,000 deaths. That’s the average seasonal flu, year in and year out. So, it’s a serious disease. And it’s particularly serious for anyone with underlying health conditions.

This flu is different, though, from seasonal flu, in that it is focusing on a much younger population. The scientists still can’t tell us exactly why, but it appears that the older Americans, those over 65, seem to have some sort of built-in immunity. And whether previous flu seasons or what exactly it is, we don’t know.

But unlike seasonal flu, this is really a young person’s flu. We’re seeing it hit in particularly dangerous populations. And I want to make it clear to you who those populations are.

Pregnant women are at health risk with H1N1, in terms of – and when I say “health risk,” it’s not getting the flu that is so dangerous, it’s becoming very ill or potentially dying from the flu. So, having this flu, for most people, you’ll feel pretty lousy for a couple of days. A little chicken soup and staying home, and you’ll be better. But there are categories which we’ve learned are particularly at risk.

So, pregnant women, Americans with chronic diseases – diabetes, neuromuscular disease, heart disease – are at particular risk. And that’s a group that, unfortunately, includes many American Indians and Alaskan Natives. And it also is disproportionately affecting healthy kids up to adult age.

Recently, we have gotten some good news. The clinical trials which are underway right now – and when you make a vaccine for a new flu, you have to do clinical trials to first see if you’ve got the right dose, to see if it’s effective against the flu, because we’ve never seen this virus before, and then to make sure there aren’t any alarming notions (ph).

So, the data on healthy adults is back. And we have learned that we are confident that adults will only need one dose. That’s good news. We thought originally it may take two doses to build up some immunity.

It also appears that there’s a very robust immune response within the first 10 days – again, good news. We thought it would be about three weeks.

And finally, we think that as early as the first week in October, we will have some vaccine beginning to be available. We have always targeted mid-October, the 15th, for vaccine to begin to roll out. But we think we could have some even earlier.

We are waiting right now for the results of the data on the youngest children, to know whether children are going to need two doses or one. Those clinical trials started after the adult trials. We’ll know more by the middle to end of next week, and we’ll keep people alerted.

There’s a great Web site, flu.gov, www.flu, F-L-U, .gov. It has information from the Centers for Disease Control, updates for everybody from employers, to families, to health care providers. It will give you regular updates on what’s happening with this and, certainly, when and where vaccine is available.

Over the next week, we intend to send far more specific information to tribal leaders that is specifically targeted about where vaccinations are going to be available and what sorts of sites will be ready. And we’ll be sending a schedule for biweekly calls that we want to use to keep you updated.

Because one of the things that we know is that this can change. I’m giving you a snapshot today on September 15th, but I want you to hear me very carefully. It may look very different in two weeks, and we need to stay in close touch.

And what we saw in the spring, which will happen again, is that there’ll be areas in the country with lots of cases, and there’ll be areas with very few. So, again, you don’t want a national picture. You want to know what’s happening in your particular area, and how this flu is presenting.

In the meantime, between now and the time vaccinations are available – and let me make it clear. We will have enough vaccine for everybody who wants to be vaccinated. It won’t all come off the production line at the same time.

And so, what we’re urging is that the target populations – health care workers, pregnant women, children under the age of 24, particularly those with underlying health conditions, and adults with underlying health conditions – kind of come to the front of the line and get the earliest possible vaccination. But there will be enough for everyone.

Steps that can be taken in the meantime are really important. They sound pretty easy, but they are incredibly effective.

Wash your hands frequently.

And wash off anything in your home or office that your hands touch. So, go over keyboards on computers or doorknobs or desktops, because what we know is that hands are the best way to transmit germs from person to person.

And, in fact, Mr. Chairman, if you would stand up for just a moment, I want to teach you the flu bump, which we may have to start to use instead of shaking hands. You ready?

So, when you greet someone …


… give them a little flu bump. OK?


As opposed to this.


Franklin: Sure will. Thank you.


Sebelius: Another – and this is not only for adults, particularly important for children. Having a raised a couple myself, I know hand-washing is sort of an alien occupation, but anything you can do to convince your kids to wash hands frequently, or use some kind of hand gel. It works. It’s very effective. But keeping hands clean.

The other thing that we really want to encourage people to do is, when you cough or sneeze, sneeze into your sleeve or a handkerchief. But don’t cover your mouth with your hands, because, again, it is really able to be transmitted.

We are trying to reach out to younger folks in every medium we possibly can. We’ve got Elmo involved from Sesame Street. We’re on Facebook. We’re tweeting. We have messages coming into college dorms.

But often, this younger population feels they’re invincible and doesn’t pay a lot of attention to health risks. So, we’re really trying to reach out.

And I think that, with your help, we can make sure that between now and the time we get vaccinations ready, we can keep folks safe and secure.

Finally, I just want to talk for one minute about budget. The administration and the Department of Health and Human Services are committed to making sure that all American Indians and Alaska Natives live longer, healthier and fulfilling lives.

And the best evidence of that, I think, is in the president’s 2010 budget. It includes a $454 million increase in our budget for the Indian Health Services. And that’s on top of the increase that came before. It’s a 13 percent increase – the largest increase in the last two decades. And that is long overdue and well deserved.


As important, the Indian Health Services received more than a half-a-billion dollars in Recovery Act money to improve facilities around the country, to invest in money-saving technologies and save jobs. And as Dr. Roubideaux said, we want to continue to hear from you, to consult with you about specific strategies for how we can do more as we move forward.

Our staff was grateful to be part of the White House discussion with tribal leaders at the end of August, and look forward to continuing the discussion at the 12th annual HHS budget consultation, sometime in the next few weeks.

So, we are at a remarkable moment in American history. We’re nearer to achieving health insurance reform than ever before. And presidents since Theodore Roosevelt have been talking about this. But as the president said so well on Wednesday night, he would like to be the last president who has to bring this to the Congress.


He would like this to be the day, and this to be the moment.


There are many groups around this country, many citizens who will benefit from health insurance reform. But I don’t have any question that those represented in this room and the tribes you represent will be significantly enhanced with the passage of this critical act. It’s not only about helping one group or another, it’s about giving all Americans the security and stability that comes with good health care.

And there’s an old Dakota Sioux proverb that says, we will be known by the tracks we leave behind. And I believe, if we keep the momentum going we already have, we’ll be known as the first generation that didn’t pass this problem along to our children, and finally got health reform done.

So, I look forward to working with all of you in the months to come. I look forward to hearing frequently from Dr. Roubideaux about your challenges and concerns, to make sure those are incorporated into the policies and procedures and initiatives that we intend to take on in Health and Human Services.

And I look forward to working with you to make sure that all Americans – particularly the first Americans – get access to the care you need for healthy and prosperous lives.

Thank you so much. And good luck and God bless.