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Today, before several hundred healthcare providers and community leaders, Senator Murray outlined her principles for healthcare in the 108th Congress. Murray spoke at 2002 annual Washington Health Legislative Conference in Seattle.

Her remarks follow:


Good morning, and thank you Greg [Greg Vigdor, President, Washington Health Foundation ] for that introduction.

I want to thank Greg and the Washington Health Foundation for being a sponsor of this conference and a leader in our state's efforts for the past decade.

It is not an exaggeration to say that our healthcare system is falling down around us. But in spite of that, patients are getting the care they need because a group of dedicated people throughout our state has a deep personal commitment to serving our patients. In this room, is the heart and the soul of that dedicated group. In the face of so many challenges, your work and your compassion have helped minimize the impact on patients.

And so before I say anything else, I want to thank you on behalf of the people of Washington State for your unsung work and for your commitment.

Looking around the room, I see a lot of familiar faces. Many of you have come to my office in Washington, D.C. to talk about healthcare issues. During those visits we've focused on one piece of the puzzle or another. Today, I'm excited to have all of you here in the same room to take a broad look at the future of healthcare in Washington State.

As the Vital Signs presentation just showed, we are facing some tough times. But it is worth the fight because so much is at stake.

On the individual level, healthcare is a service. It protects and heals, and it helps people reach their full potential. On a broader level, when it's done right, good healthcare builds strong and vibrant communities. But the reverse is also true. When we fail to meet the health needs of our residents, our communities suffer. When seniors can't find a doctor, when a new mother can't get immunizations for her child, and when a person's only chance for health care is in the emergency room, it tears at the fabric of our community – affecting not only our health but our economy and our way of life. The strength of our community is at stake, but fortunately, we go into this battle well-equipped.

Our state has an outstanding healthcare history and infrastructure from great providers and world-class research facilities to our innovative public health tradition and our leadership on issues like serving low-income children. We do have a strong base of people and resources to overcome our current challenges.

As long as the folks in this room are on the case, our state will continue to be a leader in increasing access to care.

This morning, I don't have time to address all the issues and concerns before us, but I want you to know that my staff will be here all day, and I invite you to share your ideas with them.

The truth is, with a new session of Congress set to begin in just a few weeks, I'm going to need your input.

In my limited time this morning, I want to share with you the principles that drive my work on healthcare in the United States Senate. I want to briefly mention six principles. They are:
  • empowering local efforts,
  • reaching every citizen,
  • strengthening the foundation of healthcare,
  • fighting for low-income children
  • protecting our resources,
  • and empowering all citizens to be part of the change we seek to create.

    Let's start with my first principle. Great things are happening locally, and we need to support the grassroots efforts that are making a difference.

    Over the past year, I've held roundtable discussion on healthcare throughout our state, and I've been impressed by the creative solutions that are coming from local communities.

    In healthcare, the folks on the ground have really stepped up to the plate to meet the challenges that Washington, D.C. has failed to address. I've tried to shine a light on the innovative work being done in our communities.

    I've also supported funding to help these local initiatives through efforts like CAP – the Community Access Program. CAP connects our strong public health tradition to the mission of expanding access. It's not a "top down" solution. Instead, it helps communities and safety net providers coordinate care for the uninsured. I'm very proud that Washington has four CAP grantees. They're based in Spokane, Wenatchee, Olympia, and Seattle.

    As I've met with our CAP grantees, they've shown me a glimpse into the future of healthcare. For example, in October I visited the Odessa Brown Children's Clinic. I saw a doctor, a dentist, and a psychologist all in the same room – not just treating individual body parts – but treating the whole child in a comprehensive, compassionate way. Today that project – known as "Kids Get Care" – is connecting more than 3,000 children to comprehensive healthcare. These efforts are making a real difference for low-income families, and they need more investment.

    Unfortunately, some folks in Washington, D.C. don't realize the value of these innovative approaches. In fact, the Bush Administration has tried to kill the CAP program time and again. As a member of the Senate's HELP Committee, I've been working to save the CAP program. I'm proud to report that the Health Care Safety Net bill, which I helped draft, authorizes the CAP program.

    That Children's clinic is just one example of the creative, patient-centered efforts that are improving access throughout Washington. I'm excited about the things we can do – like using telemedicine to connect a specialist in at a major hospital with a child sitting in a rural health clinic hours away.

    In Whatcom County, the Robert Wood Johnson Foundation is funding a two-year pilot project to serve those with acute diabetes and congestive heart failure. It is already making a difference.

    I share those examples with you because they are proof that some of the most innovative healthcare solutions are not coming from some Cabinet Department in Washington, D.C. but from communities large and small right here in Washington state. So when I look at healthcare, one of the first principles I remember is that our local communities are developing innovative solutions, and they deserve our support.

    My second principle is simple. Every resident of Washington must have access to healthcare. It's a simple idea, but it's going to take creativity to achieve. And the truth is we've got to recognize what's working and what's not.

    For many years, our health insurance model has been built around employers. You have a job, and your employer provides healthcare. We need to make it easier for more employers to provide health insurance through tax credits and other incentives.

    But we must also recognize that our employment-based insurance system is leaving many people behind.

    Many don't have coverage because they are out of work. Sure, they can continue to pay for health insurance through COBRA, but often it costs too much. That's where tax incentives and direct subsidies can help. But even those steps leave many without coverage - like those with part time jobs. Even many full time jobs have long waiting periods before benefits kick in. And many businesses – especially small ones – can't afford to pay for health insurance.

    In some cases, employment-based health insurance works, but in many other cases, it leaves people without coverage. To protect those who are falling through the cracks, I believe we need to invest in our healthcare safety net.

    Instead of just looking for ways to get people healthcare insurance, we need to find more ways to get people primary healthcare -- not insurance to get healthcare, but healthcare itself.

    The best vehicles for that vary from community to community. In some areas, the public health nurse, the private doctor and the public health district are providing that critical help.

    In other areas, Community Health Centers are doing the job. For Fiscal Year 2002, I've worked to provide an additional $175 million for Community Health Care Centers. That's on top of a $90 million increase. There are other direct care measures I support from the Child and Maternal Health Block Grant, to the Ryan White Care programs – where we've provided an addition $104 million to help those living with AIDS and HIV. [Fiscal Year 2002]

    Our safety net must include rural and isolated communities. I've worked to continue the Health Professions Training program – which trains those who serve in rural communities.

    Finally, when we talk about our health care and the public health safety net after September 11th, 2001, we need to talk about our response to bioterrorism. Through my committee assignments, I've worked to boost our federal investment in this area especially after visiting our Public Health Lab and seeing their critical work.

    Our investment in bioterrorism preparedness cannot be a one-time deal. It must be a sustained commitment – so that our state's public health officials can prepare for bioterrorism without taking away from their day-to-day work.

    Bioterrorism is just newest challenge we face, but it shows the importance of our public health infrastructure. We can ensure that every resident has access to care by on the one hand -- strengthening and encouraging employment-based health insurance, and on the other -- increasing our investment in direct primary healthcare. Let me turn to my third principle.

    We must strengthen the foundation of healthcare in Washington – and that foundation is Medicare.

    Medicare isn't just a service for seniors or the disabled. It is the heart of healthcare in Washington. It trains our doctors. It keeps our emergency rooms open. And in rural areas – it "keeps the lights on" in the only hospital for miles.

    Unfortunately, many doctors aren't accepting Medicare. In part, that's becauseWashington state receives far below the national average in Medicare payments per patient. This year, I wrote and introduced the MediFair Act to ensure all states receive at least the national average in Medicare payments per patient. For more information on my MediFair Act, I invite you to visit my website.

    I've also worked to pass a Medicare Provider Package to stop imminent cuts in doctors' payments, home healthcare, and other areas. During the last Congress, we tried to bring up this critical legislation twice, but both times our efforts were stopped by the Republican leadership.

    We also need to modernize Medicare by adding a real prescription drug benefit and boosting our focus on preventing diseases like osteoporosis. We can strengthen Medicare so it does a better job of helping seniors and the disabled. And while we're at it, there is another vulnerable group that needs special help so let me turn to my fourth healthcare principle.

    We must protect low-income children.

    Washington state has a proud tradition of going the extra mile to serve low-income kids including through the CHIP program.

    But today, our state can't use that money where it's needed most – on children who are under 200 percent of poverty and currently covered through Medicaid.

    In the Senate, I've worked on this issue with Senator Cantwell and others. We inserted a fix to this problem in the Medicare provider package, which unfortunately was blocked in the final weeks of the 107th Congress.

    But I'm not going to give up, and I can tell you that the new Chairman of the Senate Finance Committee has made a commitment to correct this problem in any provider package that the Senate takes up in January

    Let me say a brief word about Medicaid, which is under tremendous strain these days.

    States like Washington have expanded our commitment to help the low-income and disabled. Unfortunately, the federal government has not kept up with the growing needs. I've fought to increase the federal share of Medicaid. When the Senate was under Democratic control, we passed a small increase in the federal Medicaid match. It would have provided another $200 million for our state.

    Unfortunately, the White House and Republican leadership felt that it was not needed and was too costly. They think states should do more with less. Those of us here in Washington state know that's not possible.

    So in the 108th Congress, I will continue to work to make sure the federal government provides its proper share of Medicaid funding.

    My fifth principle is that we must maintain the healthcare resources that we have today. That means keeping our doctors and nurses from leaving our state. To keep doctors here -- as I mentioned earlier – we need to make Medicare rates more fair, and we need to stop the pending cuts in doctors' payments. The provider package I worked on would have increased doctors' payments by 2.5 percent.

    We also need to address the nursing shortage, which I know you'll be discussing later today. Our state is losing good nurses because of low wages and often overwhelming workloads, and it is affecting patient care.

    As a member of the Health and Appropriations Committees, I secured $1 million in the past year to improve nurse retention. With that money, the Washington Health Foundation will -- survey nurses to discover the best retention strategies -- and then will establish six demonstration projects throughout Washington to put these best practices to work.

    In addition, as a member of the HELP Committee, I worked to pass the Nurse Reinvestment Act, which focuses new resources on nurse recruitment and retention. Let me turn to my final principle.

    We must bring everyone in our state together to force the changes we seek.

    We need to educate healthcare consumers about the choices they're making. Education can help prevent many chronic conditions.

    I'm excited about the work our local schools are doing to educate children about diet and excercise -- helping them to set healthy habits for a lifetime.

    Another way to bring people into the healthcare debate is to show them what's at stake in their own lives.

    Let's face it, not everyone knows the difference between CHIP and CAP and the Federal Medicaid Match.

    But most residents do know that ER shouldn't be the first place for primary care. They know it. They just don't have a choice today.

    We need to get them involved in the discussion. They want a better system -- a system that will meet their needs – and we need their support to make it happen.

    Bringing health care consumers into our coalition will give us the broad support we need to improve healthcare, and ultimately, to strengthen our communities.

    In closing, let me admit that we've got our work cut out for us. Some will tell you it can't be done. In my own life, I've made a habit of proving those folks nay sayers wrong. We've got a proud tradition. We've got citizens and communities that need our help. And we've got dedicated people in this room who will fight until we get it done.

    As Margaret Mead famously said, "Never doubt that a small group of thoughtful committed citizens can change the world. Indeed it's the only thing that ever has."

    Friends, let's get started!