Health Care Blog

22 Pens

On Tuesday, the President signed the Patient Protection and Affordable Care Act, one of the most significant bills signed into law in the last several decades. Among the many stories generated by the passing of this landmark health reform bill were several that focused on the President using 22 pens to sign the bill into law. The fact that the Staff Secretary handles such bill signings has led a number of people to ask exactly what the Staff Secretary does. While the Staff Secretary can play a public role at the signing of a major bill, Executive Order or international agreement, the lion’s share of the office’s work is invisible to the public.

All of the paper that goes to the President (including, with rare exception, classified memos from the National Security Advisor), goes through the Staff Secretary’s Office. Working with staff throughout the White House, the Office compiles the President’s daily briefing book; reviews and edits briefing and decision memos, circulating them within the White House for input before they go to the President; handles executive orders and bills; and organizes the letters and background reading sent to the President.

The role of the Staff Secretary is often described as the last substantive control point before papers reach the Oval Office.” Does a memo merit the President’s attention given the demands on his time? Does a memo provide the President with the information he needs for a meeting? Are the various aspects of an issue clearly presented for the President’s decision? Are all the relevant views of the President’s senior advisors reflected so he can make a fully informed decision? The Staff Secretary serves as the “honest broker,” ensuring that the paper going to the President is ready for prime time and that no one who should be in the loop is cut out of the process.

The paper ranges from the mundane to the momentous. As of yesterday, President Obama has signed 147 bills into law. While each has significance in its own right, none matches the import of the health reform bill for Americans across the country. As the President said, “this is what change looks like,” and it is why I work for President Obama and why it is an honor to work in this office.

Lisa Brown is Assistant to the President and Staff Secretary

What's in the Health Care Bill?

On the day that President Obama signed health insurance reform into law, a lot of Americans are researching the final legislation and how it affects them.  As the President helpfully pointed out in his speech earlier today:

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 we want to make sure you don’t miss a bunch of health care reform resources on our website:

• Frequently asked questions
• A title-by-title health care reform bill summary
• A list of all recent blog posts about health care
• Links to full text of the health care bill: H.R. 4872 - Health Care and Education Affordability Reconciliation Act of 2010 and an area to submit your comment on the legislation

Today, White House Director of Health Reform Nancy-Ann DeParle sent an email update (you can sign up for them here) outlining key benefits of health reform for individual Americans that take place soon: 

FROM: Nancy-Ann DeParle, The White House
SUBJECT: What Happens Next

Good afternoon,

Since the House of Representatives voted to pass health reform legislation on Sunday night, the legislative process and its political impact have been the focus of all the newspapers and cable TV pundits.

Outside of DC, however, many Americans are trying to cut through the chatter and get to the substance of reform with a simple question: "What does health insurance reform actually mean for me?" To help, we've put together a list of some key benefits every American should know.

Let's start with how health insurance reform will expand and strengthen coverage:

• This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.
• This year, health care plans will allow young people to remain on their parents' insurance policy up until their 26th birthday.
• This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.
• This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.
• In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.
• This year, we'll also establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country's needs.  Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners -- on top of a $500 million investment from the American Recovery and Reinvestment Act.

Health insurance reform will also curb some of the worst insurance industry practices and strengthen consumer protections:

• This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.
• This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.
• Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies.
• Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don't meet those thresholds will be required to provide rebates to their policyholders.
• Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.

Reform immediately begins to lower health care costs for American families and small businesses:

• This year, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.
• This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.
• This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.
• This year, this bill starts to close the Medicare Part D 'donut hole' by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the 'donut hole.'

Thank you,

Nancy-Ann DeParle
Director, White House Office of Health Reform