Barack H. Obama Address to Congress on Health Care (2009)

Remarks of President Barack Obama – As Prepared for Delivery
Address to a Joint Session of Congress on Health Care
Wednesday, September 9th, 2009
Washington, DC

Madame Speaker, Vice President Biden, Members of Congress, and the American 
people: 

When I spoke here last winter, this nation was facing the worst economic crisis since the 
Great Depression. We were losing an average of 700,000 jobs per month. Credit was 
frozen. And our financial system was on the verge of collapse.

As any American who is still looking for work or a way to pay their bills will tell you, 
we are by no means out of the woods. A full and vibrant recovery is many months 
away. And I will not let up until those Americans who seek jobs can find them; until 
those businesses that seek capital and credit can thrive; until all responsible 
homeowners can stay in their homes. That is our ultimate goal. But thanks to the bold 
and decisive action we have taken since January, I can stand here with confidence and 
say that we have pulled this economy back from the brink.

I want to thank the members of this body for your efforts and your support in these last 
several months, and especially those who have taken the difficult votes that have put us 
on a path to recovery. I also want to thank the American people for their patience and 
resolve during this trying time for our nation.

But we did not come here just to clean up crises. We came to build a future. So tonight, 
I return to speak to all of you about an issue that is central to that future – and that is 
the issue of health care.

I am not the first President to take up this cause, but I am determined to be the last. It 
has now been nearly a century since Theodore Roosevelt first called for health care 
reform. And ever since, nearly every President and Congress, whether Democrat or 
Republican, has attempted to meet this challenge in some way. A bill for 
comprehensive health reform was first introduced by John Dingell Sr. in 1943. 
Sixtyfive years later, his son continues to introduce that same bill at the beginning of each 
session.Our collective failure to meet this challenge – year after year, decade after decade – has 
led us to a breaking point. Everyone understands the extraordinary hardships that are 
placed on the uninsured, who live every day just one accident or illness away from 
bankruptcy. These are not primarily people on welfare. These are middle-class 
Americans. Some can’t get insurance on the job. Others are self-employed, and can’t 
afford it, since buying insurance on your own costs you three times as much as the 
coverage you get from your employer.   Many other Americans who are willing and 
able to pay are still denied insurance due to previous illnesses or conditions that 
insurance companies decide are too risky or expensive to cover.

We are the only advanced democracy on Earth – the only wealthy nation – that allows 
such hardships for millions of its people. There are now more than thirty million 
American citizens who cannot get coverage. In just a two year period, one in every 
three Americans goes without health care coverage at some point. And every day, 
14,000 Americans lose their coverage. In other words, it can happen to anyone. 
But the problem that plagues the health care system is not just a problem of the 
uninsured. Those who do have insurance have never had less security and stability 
than they do today.   

More and more Americans worry that if you move, lose your job, 
or change your job, you’ll lose your health insurance too. More and more Americans 
pay their premiums, only to discover that their insurance company has dropped their 
coverage when they get sick, or won’t pay the full cost of care. It happens every day.
One man from Illinois lost his coverage in the middle of chemotherapy because his 
insurer found that he hadn’t reported gallstones that he didn’t even know about. They 
delayed his treatment, and he died because of it. Another woman from Texas was 
about to get a double mastectomy when her insurance company canceled her policy 
because she forgot to declare a case of acne. By the time she had her insurance 
reinstated, her breast cancer more than doubled in size. That is heart-breaking, it is 
wrong, and no one should be treated that way in the United States of America.

Then there’s the problem of rising costs. We spend one-and-a-half times more per 
person on health care than any other country, but we aren’t any healthier for it. This is 
one of the reasons that insurance premiums have gone up three times faster than 
wages. It’s why so many employers – especially small businesses – are forcing their 
employees to pay more for insurance, or are dropping their coverage entirely. It’s why 
so many aspiring entrepreneurs cannot afford to open a business in the first place, and 
why American businesses that compete internationally – like our automakers – are at a 
huge disadvantage. And it’s why those of us with health insurance are also paying a 
hidden and growing tax for those without it – about $1000 per year that pays for 
somebody else’s emergency room and charitable care.Finally, our health care system 
is placing an unsustainable burden on taxpayers. 

When health care costs grow at the rate they have, it puts greater pressure on programs like 
Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will 
eventually be spending more on Medicare and Medicaid than every other government 
program combined. Put simply, our health care problem is our deficit problem.
Nothing else even comes close.  

These are the facts. Nobody disputes them. We know we must reform this system.
The question is how.

There are those on the left who believe that the only way to fix the system is through a 
single-payer system like Canada’s, where we would severely restrict the private 
insurance market and have the government provide coverage for everyone. On the 
right, there are those who argue that we should end the employer-based system and 
leave individuals to buy health insurance on their own.

I have to say that there are arguments to be made for both approaches. But either one 
would represent a radical shift that would disrupt the health care most people currently 
have. Since health care represents one-sixth of our economy, I believe it makes more 
sense to build on what works and fix what doesn’t, rather than try to build an entirely 
new system from scratch. And that is precisely what those of you in Congress have 
tried to do over the past several months.

During that time, we have seen Washington at its best and its worst.

We have seen many in this chamber work tirelessly for the better part of this year to 
offer thoughtful ideas about how to achieve reform. Of the five committees asked to 
develop bills, four have completed their work, and the Senate Finance Committee 
announced today that it will move forward next week. That has never happened 
before. Our overall efforts have been supported by an unprecedented coalition of 
doctors and nurses; hospitals, seniors’ groups and even drug companies – many of 
whom opposed reform in the past. And there is agreement in this chamber on about 
eighty percent of what needs to be done, putting us closer to the goal of reform than we 
have ever been.

But what we have also seen in these last months is the same partisan spectacle that only 
hardens the disdain many Americans have toward their own government. Instead of 
honest debate, we have seen scare tactics. Some have dug into unyielding ideological 
camps that offer no hope of compromise. Too many have used this as an opportunity to 
score short-term political points, even if it robs the country of our opportunity to solve a 
long-term challenge. And out of this blizzard of charges and counter-charges, 
confusion has reigned.Well the time for bickering is over. The time for games has passed. 

Now is the season for action. Now is when we must bring the best ideas of both parties together, and 
show the American people that we can still do what we were sent here to do. Now is 
the time to deliver on health care.

The plan I’m announcing tonight would meet three basic goals:
It will provide more security and stability to those who have health insurance. It will 
provide insurance to those who don’t. And it will slow the growth of health care costs 
for our families, our businesses, and our government. It’s a plan that asks everyone to 
take responsibility for meeting this challenge – not just government and insurance 
companies, but employers and individuals. And it’s a plan that incorporates ideas from 
Senators and Congressmen; from Democrats and Republicans – and yes, from some of 
my opponents in both the primary and general election.   

Here are the details that every American needs to know about this plan:
First, if you are among the hundreds of millions of Americans who already have health 
insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will 
require you or your employer to change the coverage or the doctor you have. Let me 
repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to make the insurance you have work better for you. Under 
this plan, it will be against the law for insurance companies to deny you coverage 
because of a pre-existing condition. As soon as I sign this bill, it will be against the law 
for insurance companies to drop your coverage when you get sick or water it down 
when you need it most. They will no longer be able to place some arbitrary cap on the 
amount of coverage you can receive in a given year or a lifetime. We will place a limit 
on how much you can be charged for out-of-pocket expenses, because in the United 
States of America, no one should go broke because they get sick. And insurance 
companies will be required to cover, with no extra charge, routine checkups and 
preventive care, like mammograms and colonoscopies – because there’s no reason we 
shouldn’t be catching diseases like breast cancer and colon cancer before they get 
worse. That makes sense, it saves money, and it saves lives. 
  
That’s what Americans who have health insurance can expect from this plan – more 
security and stability.

Now, if you’re one of the tens of millions of Americans who don’t currently have health 
insurance, the second part of this plan will finally offer you quality, affordable choices.
If you lose your job or change your job, you will be able to get coverage. If you strike 
out on your own and start a small business, you will be able to get coverage. We will 
do this by creating a new insurance exchange – a marketplace where individuals and
 small businesses will be able to shop for health insurance at competitive prices.

Insurance companies will have an incentive to participate in this exchange because it 
lets them compete for millions of new customers. As one big group, these customers 
will have greater leverage to bargain with the insurance companies for better prices and 
quality coverage. This is how large companies and government employees get 
affordable insurance. It’s how everyone in this Congress gets affordable insurance.
And it’s time to give every American the same opportunity that we’ve given ourselves.
For those individuals and small businesses who still cannot afford the lower-priced 
insurance available in the exchange, we will provide tax credits, the size of which will 
be based on your need. And all insurance companies that want access to this new 
marketplace will have to abide by the consumer protections I already mentioned. This 
exchange will take effect in four years, which will give us time to do it right. In the 
meantime, for those Americans who can’t get insurance today because they have 
preexisting medical conditions, we will immediately offer low-cost coverage that will 
protect you against financial ruin if you become seriously ill. This was a good idea 
when Senator John McCain proposed it in the campaign, it’s a good idea now, and we 
should embrace it.

Now, even if we provide these affordable options, there may be those – particularly the 
young and healthy – who still want to take the risk and go without coverage. There 
may still be companies that refuse to do right by their workers. The problem is, such 
irresponsible behavior costs all the rest of us money. If there are affordable options and 
people still don’t sign up for health insurance, it means we pay for those people’s 
expensive emergency room visits. If some businesses don’t provide workers health 
care, it forces the rest of us to pick up the tab when their workers get sick, and gives 
those businesses an unfair advantage over their competitors. And unless everybody 
does their part, many of the insurance reforms we seek – especially requiring insurance 
companies to cover pre-existing conditions – just can’t be achieved.

That’s why under my plan, individuals will be required to carry basic health insurance 
– just as most states require you to carry auto insurance. Likewise, businesses will be 
required to either offer their workers health care, or chip in to help cover the cost of 
their workers. There will be a hardship waiver for those individuals who still cannot 
afford coverage, and 95% of all small businesses, because of their size and narrow profit 
margin, would be exempt from these requirements. But we cannot have large 
businesses and individuals who can afford coverage game the system by avoiding 
responsibility to themselves or their employees. Improving our health care system only 
works if everybody does their part.

While there remain some significant details to be ironed out, I believe a broad 
consensus exists for the aspects of the plan I just outlined: consumer protections for 
those with insurance, an exchange that allows individuals and small businesses to purchase
 affordable coverage, and a requirement that people who can afford insurance 
get insurance.

And I have no doubt that these reforms would greatly benefit Americans from all walks 
of life, as well as the economy as a whole. Still, given all the misinformation that’s been 
spread over the past few months, I realize that many Americans have grown nervous 
about reform. So tonight I’d like to address some of the key controversies that are still 
out there.

Some of people’s concerns have grown out of bogus claims spread by those whose only 
agenda is to kill reform at any cost. The best example is the claim, made not just by 
radio and cable talk show hosts, but prominent politicians, that we plan to set up panels 
of bureaucrats with the power to kill off senior citizens. Such a charge would be 
laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.
There are also those who claim that our reform effort will insure illegal immigrants.
This, too, is false – the reforms I’m proposing would not apply to those who are here 
illegally. And one more misunderstanding I want to clear up – under our plan, no 
federal dollars will be used to fund abortions, and federal conscience laws will remain 
in place.

My health care proposal has also been attacked by some who oppose reform as a 
“government takeover” of the entire health care system. As proof, critics point to a 
provision in our plan that allows the uninsured and small businesses to choose a 
publicly-sponsored insurance option, administered by the government just like 
Medicaid or Medicare.

So let me set the record straight. My guiding principle is, and always has been, that 
consumers do better when there is choice and competition. Unfortunately, in 34 states, 
75% of the insurance market is controlled by five or fewer companies. In Alabama, 
almost 90% is controlled by just one company. Without competition, the price of 
insurance goes up and the quality goes down. And it makes it easier for insurance 
companies to treat their customers badly – by cherry-picking the healthiest individuals 
and trying to drop the sickest; by overcharging small businesses who have no leverage; 
and by jacking up rates. 

Insurance executives don’t do this because they are bad people. They do it because it’s 
profitable. As one former insurance executive testified before Congress, insurance 
companies are not only encouraged to find reasons to drop the seriously ill; they are 
rewarded for it. All of this is in service of meeting what this former executive called 
“Wall Street’s relentless profit expectations.” Now, I have no interest in putting insurance 
companies out of business. They provide a 
legitimate service, and employ a lot of our friends and neighbors. I just want to hold 
them accountable. The insurance reforms that I’ve already mentioned would do just 
that. But an additional step we can take to keep insurance companies honest is by 
making a not-for-profit public option available in the insurance exchange. Let me be 
clear – it would only be an option for those who don’t have insurance. No one would 
be forced to choose it, and it would not impact those of you who already have 
insurance. In fact, based on Congressional Budget Office estimates, we believe that less 
than 5% of Americans would sign up. 

Despite all this, the insurance companies and their allies don’t like this idea. They 
argue that these private companies can’t fairly compete with the government. And 
they’d be right if taxpayers were subsidizing this public insurance option. But they 
won’t be.  I have insisted that like any private insurance company, the public insurance 
option would have to be self-sufficient and rely on the premiums it collects. But by 
avoiding some of the overhead that gets eaten up at private companies by profits, 
excessive administrative costs and executive salaries, it could provide a good deal for 
consumers. It would also keep pressure on private insurers to keep their policies 
affordable and treat their customers better, the same way public colleges and 
universities provide additional choice and competition to students without in any way 
inhibiting a vibrant system of private colleges and universities. 

It’s worth noting that a strong majority of Americans still favor a public insurance 
option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by 
the left, the right, or the media. It is only one part of my plan, and should not be used 
as a handy excuse for the usual Washington ideological battles. To my progressive 
friends, I would remind you that for decades, the driving idea behind reform has been 
to end insurance company abuses and make coverage affordable for those without it.
The public option is only a means to that end – and we should remain open to other 
ideas that accomplish our ultimate goal. And to my Republican friends, I say that 
rather than making wild claims about a government takeover of health care, we should 
work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect only in 
those markets where insurance companies are not providing affordable policies. Others 
propose a co-op or another non-profit entity to administer the plan. These are all 
constructive ideas worth exploring. But I will not back down on the basic principle that 
if Americans can’t find affordable coverage, we will provide you with a choice. And I 
will make sure that no government bureaucrat or insurance company bureaucrat gets 
between you and the care that you need.

Finally, let me discuss an issue that is a great concern to me, to members of this 
chamber, and to the public – and that is how we pay for this plan.Here’s what you need to 
know. First, I will not sign a plan that adds one dime to our 
deficits – either now or in the future. Period. And to prove that I’m serious, there will 
be a provision in this plan that requires us to come forward with more spending cuts if 
the savings we promised don’t materialize. Part of the reason I faced a trillion dollar 
deficit when I walked in the door of the White House is because too many initiatives 
over the last decade were not paid for – from the Iraq War to tax breaks for the 
wealthy. I will not make that same mistake with health care.  

Second, we’ve estimated that most of this plan can be paid for by finding savings within 
the existing health care system – a system that is currently full of waste and abuse.
Right now, too much of the hard-earned savings and tax dollars we spend on health 
care doesn’t make us healthier.  That’s not my judgment – it’s the judgment of medical 
professionals across this country. And this is also true when it comes to Medicare and 
Medicaid.

In fact, I want to speak directly to America’s seniors for a moment, because Medicare is 
another issue that’s been subjected to demagoguery and distortion during the course of 
this debate. 

More than four decades ago, this nation stood up for the principle that after a lifetime of 
hard work, our seniors should not be left to struggle with a pile of medical bills in their 
later years. That is how Medicare was born. And it remains a sacred trust that must be 
passed down from one generation to the next. That is why not a dollar of the Medicare 
trust fund will be used to pay for this plan.

The only thing this plan would eliminate is the hundreds of billions of dollars in waste 
and fraud, as well as unwarranted subsidies in Medicare that go to insurance 
companies – subsidies that do everything to pad their profits and nothing to improve 
your care. And we will also create an independent commission of doctors and medical 
experts charged with identifying more waste in the years ahead.   

These steps will ensure that you – America’s seniors – get the benefits you’ve been 
promised. They will ensure that Medicare is there for future generations. And we can 
use some of the savings to fill the gap in coverage that forces too many seniors to pay 
thousands of dollars a year out of their own pocket for prescription drugs. That’s what 
this plan will do for you.  So don’t pay attention to those scary stories about how your 
benefits will be cut – especially since some of the same folks who are spreading these 
tall tales have fought against Medicare in the past, and just this year supported a budget 
that would have essentially turned Medicare into a privatized voucher program. That 
will never happen on my watch. I will protect Medicare.      Now, because Medicare is such 
a big part of the health care system, making the 
program more efficient can help usher in changes in the way we deliver health care that 
can reduce costs for everybody. We have long known that some places, like the 
Intermountain Healthcare in Utah or the Geisinger Health System in rural 
Pennsylvania, offer high-quality care at costs below average. The commission can help 
encourage the adoption of these common-sense best practices by doctors and medical 
professionals throughout the system – everything from reducing hospital infection rates 
to encouraging better coordination between teams of doctors.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this 
plan. Much of the rest would be paid for with revenues from the very same drug and 
insurance companies that stand to benefit from tens of millions of new customers. This 
reform will charge insurance companies a fee for their most expensive policies, which 
will encourage them to provide greater value for the money – an idea which has the 
support of Democratic and Republican experts. And according to these same experts, 
this modest change could help hold down the cost of health care for all of us in the longrun.
Finally, many in this chamber – particularly on the Republican side of the aisle – have 
long insisted that reforming our medical malpractice laws can help bring down the cost 
of health care. I don't believe malpractice reform is a silver bullet, but I have talked to 
enough doctors to know that defensive medicine may be contributing to unnecessary 
costs. So I am proposing that we move forward on a range of ideas about how to put 
patient safety first and let doctors focus on practicing medicine. I know that the Bush 
Administration considered authorizing demonstration projects in individual states to 
test these issues. It’s a good idea, and I am directing my Secretary of Health and Human 
Services to move forward on this initiative today.

Add it all up, and the plan I’m proposing will cost around $900 billion over ten years –
less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for 
the wealthiest few Americans that Congress passed at the beginning of the previous 
administration. Most of these costs will be paid for with money already being spent –
but spent badly – in the existing health care system. The plan will not add to our 
deficit. The middle-class will realize greater security, not higher taxes. And if we are 
able to slow the growth of health care costs by just one-tenth of one percent each year, it 
will actually reduce the deficit by $4 trillion over the long term.

This is the plan I’m proposing. It’s a plan that incorporates ideas from many of the 
people in this room tonight – Democrats and Republicans. And I will continue to seek 
common ground in the weeks ahead. If you come to me with a serious set of proposals, 
I will be there to listen. My door is always open.But know this: I will not waste time with 
those who have made the calculation that it’s 
better politics to kill this plan than improve it. I will not stand by while the special 
interests use the same old tactics to keep things exactly the way they are. If you 
misrepresent what’s in the plan, we will call you out. And I will not accept the status 
quo as a solution. Not this time. Not now. 

Everyone in this room knows what will happen if we do nothing. Our deficit will 
grow. More families will go bankrupt. More businesses will close. More Americans 
will lose their coverage when they are sick and need it most. And more will die as a 
result. We know these things to be true.

That is why we cannot fail. Because there are too many Americans counting on us to 
succeed – the ones who suffer silently, and the ones who shared their stories with us at 
town hall meetings, in emails, and in letters. 

I received one of those letters a few days ago. It was from our beloved friend and 
colleague, Ted Kennedy. He had written it back in May, shortly after he was told that 
his illness was terminal. He asked that it be delivered upon his death.
In it, he spoke about what a happy time his last months were, thanks to the love and 
support of family and friends, his wife, Vicki, and his children, who are here tonight .
And he expressed confidence that this would be the year that health care reform – “that 
great unfinished business of our society,” he called it – would finally pass. He repeated 
the truth that health care is decisive for our future prosperity, but he also reminded me 
that “it concerns more than material things.” “What we face,” he wrote, “is above all a 
moral issue; at stake are not just the details of policy, but fundamental principles of 
social justice and the character of our country.”

I’ve thought about that phrase quite a bit in recent days – the character of our country.
One of the unique and wonderful things about America has always been our self reliance,
 our rugged individualism, our fierce defense of freedom and our healthy 
skepticism of government. And figuring out the appropriate size and role of 
government has always been a source of rigorous and sometimes angry debate.   
For some of Ted Kennedy’s critics, his brand of liberalism represented an affront to 
American liberty. In their mind, his passion for universal health care was nothing more 
than a passion for big government.

But those of us who knew Teddy and worked with him here – people of both parties –
know that what drove him was something more. His friend, Orrin Hatch, knows that.
They worked together to provide children with health insurance. His friend John 
McCain knows that. They worked together on a Patient’s Bill of Rights. His friend Chuck
 Grassley knows that. They worked together to provide health care to children 
with disabilities.

On issues like these, Ted Kennedy’s passion was born not of some rigid ideology, but of 
his own experience. It was the experience of having two children stricken with cancer.
He never forgot the sheer terror and helplessness that any parent feels when a child is 
badly sick; and he was able to imagine what it must be like for those without insurance; 
what it would be like to have to say to a wife or a child or an aging parent – there is 
something that could make you better, but I just can’t afford it.

That large-heartedness – that concern and regard for the plight of others – is not a 
partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the 
American character. Our ability to stand in other people’s shoes. A recognition that we 
are all in this together; that when fortune turns against one of us, others are there to 
lend a helping hand. A belief that in this country, hard work and responsibility should 
be rewarded by some measure of security and fair play; and an acknowledgement that 
sometimes government has to step in to help deliver on that promise. 

This has always been the history of our progress. In 1933, when over half of our seniors 
could not support themselves and millions had seen their savings wiped away, there 
were those who argued that Social Security would lead to socialism. But the men and 
women of Congress stood fast, and we are all the better for it. In 1965, when some 
argued that Medicare represented a government takeover of health care, members of 
Congress, Democrats and Republicans, did not back down. They joined together so that 
all of us could enter our golden years with some basic peace of mind.  

You see, our predecessors understood that government could not, and should not, solve 
every problem. They understood that there are instances when the gains in security 
from government action are not worth the added constraints on our freedom. But they 
also understood that the danger of too much government is matched by the perils of too 
little; that without the leavening hand of wise policy, markets can crash, monopolies
can stifle competition, and the vulnerable can be exploited. And they knew that when 
any government measure, no matter how carefully crafted or beneficial, is subject to 
scorn; when any efforts to help people in need are attacked as un-American; when facts 
and reason are thrown overboard and only timidity passes for wisdom, and we can no 
longer even engage in a civil conversation with each other over the things that truly 
matter – that at that point we don’t merely lose our capacity to solve big challenges. We 
lose something essential about ourselves.

What was true then remains true today. I understand how difficult this health care 
debate has been. I know that many in this country are deeply skeptical that 
government is looking out for them.  I understand that the politically safe move would
 be to kick the can further down the road – to defer reform one more year, or one more 
election, or one more term.

But that’s not what the moment calls for. That’s not what we came here to do. We did 
not come to fear the future. We came here to shape it. I still believe we can act even 
when it’s hard. I still believe we can replace acrimony with civility, and gridlock with 
progress. I still believe we can do great things, and that here and now we will meet
history’s test. 

Because that is who we are. That is our calling. That is our character. Thank you, God 
Bless You, and may God Bless the United States of America.
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