Good morning, good morning. It is wonderful to feel such energy and this room. Im honored to be the dean of American UniversityWashington College of law. Welcome to the Washington College of law. Next step in Health Reform 2017 conference. This year in partnership with the American Society of law, medicine and a the generous support of our cosponsors we are thrilled to have expanded the event to a 3 Day Conference attracting speakers and attendees from the academy and practice. Importantly, this conference is timed with the launch of our new policy program. I know our faculty and students will be partnering with you and your important work in the areas of healthcare, law and economics. Thank you and please join me in welcoming American University provost doctor scott bass will introduce our American University president , Sylvia Matthews burwell. Thank you. [applause] thank you, dean nelson and welcome to all of you. My pleasure to introduce the next keynote speaker, Sylvia Matthews burwell. President burwell is a visionary leader with varied and extensive experience in the public and private sectors. Her career is a testament to a lifelong commitment to advancing solutions to the worlds most pressing challenges. Her fast government experience includes positions such as secretary of health and human services, director of the office of management and budget, deputy chief of staff to the president of the United States, chief of staff, secretary of the Treasury Department and special assistant to the director of National Economic council. In the private sector, she served as chief operating officer and president of the gullible Development Program of the bill and Melinda Gates foundation and also served as president of the hallmark foundation. In response to todays session on healthcare i would like to take a minute to highlight her accomplishments and expertise in the health sector. In a recent role as secretary of health and human services, she helped shape the vision which is to ensure that every american would have access to the Building Blocks of a healthy and productive life. To this end she had oversight and management of the permit of state agencies and programs which include among others the centers for Disease Control and prevention, centers for medicare and medicaid services, the fda and National Institutes of health, she oversaw the implementation of the Affordable Care act which is this audience knows represents the most complete overhaul of the Health Care System in our nation at history. The aca ultimately helped more than 20 million americans obtain Health Coverage, it improved the quality of Health Coverage and made improvements to bend the cost curve. When she assumed leadership of hhs prior to the second open enrollment of aca one of the first priorities was improving Service Delivery of the healthcare. Gov website. As a result enrollment in aca which was previously cited as stumbling block for the programs success became more efficient and smoother. During her tenure, secretary burwell oversaw the domestic and Global Response to two an expected major health crises, the ebola epidemic and spread of the zika virus. This response included working with other nations to slow the spread of ebola in west africa, building a system to effectively identify highrisk individuals entering the United States, establishing a network of hospitals across the country to serve as Treatment Centers and investing in the research and development of an ebola virus vaccine, similar, she led hhs work to aggressively prevent, detect and respond to the zika virus including research and development and testing the zika vaccine. Throughout her leadership, Sylvia Burwell has had a significant impact, safety and Services Provided for the wealthy americans of all ages, abilities and associated economic backgrounds. Perhaps the work that is closest to home for her at hhs was her implementation of the Early Childhood program, head started at the earliest revision in 40 years. Sylvia burwell had her Early Education beginnings that head started in west virginia. She cites this program as sparking her love for learning, foundational tool and she has carried that throughout her career in public service. This community is excited to have such an outstanding and accomplished Public Servant at our home. She earned her bachelors degree in government at Harvard University with ba in philosophy, politics and economics from the university of oxford as a rhodes scholar. Her work has touched and improved the lives of many in terms of health, safety, of millions of americans, please join me in welcoming Sylvia Burwell to the podium where she shares her insights on the future of healthcare. Thank you. [applause] thank you for those kind words and your leadership here at American University. Also want to thank you for your advice and guidance in these first few months as i have joined this American University family. I think the American Society of medicine, law and ethics for bringing together such a great group of people and speakers and i want to thank American University college of law and policy programs. I dont have a law degree myself so i have more than my fair share of Supreme Court cases named for me. And if i could log one complaint about my previous job it was not one but two lawyers who failed to warn me that once confirmed all court cases switched to my name. The first, the burwell family council, my husband, stephen burwell, the second, the 44th president of the United States of america and a little heads up would have been nice. My transition to American University is interesting, exciting and challenging. I have joined a passionate, engaged Campus Community thinking, learning and doing about the worlds most interesting and important problems and one of those we are talking about here today. I have taken on a new title without ever having gone to a diner in iowa. Rather than look back i am pleased this conference is looking forward. Our nations Healthcare System has come a long way in the past 7 years. We help more people access coverage and care. We have improved the quality of Health Care Coverage for American Families and we have started to bend that cost curve cleaning up resources for todays working family and future generations. When i say we i mean our nation as a whole. This is in the work of government or business alone. It is the work of policymakers and physicians, advocates and attorneys, patients and families and as this conference proves, they are not slowing down. When i started planning for these remarks i looked closely at the agenda and two things came to mind. First, jealousy, my team reminded me know, i could not block off two days on my schedule and come and listen to all the sessions but seconds. Appreciation for the union and yank in American Health care. There are very few areas of policy that are one so complex and so simple. Todays agenda speaks to the complexity. From payment incentives to federal and state coverage of Young Children to the challenges facing payers and providers, this conference is a vast ocean of legal regulatory and moral questions that churn every day in our Healthcare System at this complex system is grounded in a simple reality. In moments of joy, or pay like a sprained ankle or fear and uncertainty is in a fight against cancer, we all count on the system, and when i worked at hhs the complexity surrounded us. We spent late nights and early mornings wading through reams of briefings and studies thanks to the academics in the room producing this, spoke with over 100,000 providers to get their input on rules of the making. We try to understand how the system was working, where there were opportunities and how to use our short time at the helm of the ship to deliver meaningful impacts to American Families. For those colleague still at hhs today, career Public Servants who deliver impact for the American People who transitioned and transferred the power to those through staff, it was an honor to serve alongside you and our nation is stronger for your service. [applause] at hhs, impact was our northstar. Our goal was to tether our conversation and analysis to facts, to experience and the reality on the ground. One sees this reality every day at hhs, you see it on the campuses of the National Institutes of health where the nations top medical researchers are crossing the next frontier of our understanding of diseases and cures through things like Precision Medicine ends on the campus of the fda where our nations safety and innovation are front and center, in the fearless men and women who pack their bags, left their own families to save families in west africa from ebola and are ready to make that perilous journey when they get called. You see the reality in head start classrooms where young minds of today have a chance to become scholars and leaders of tomorrow and in the healthcare professionals, some in this audience this morning who are trying to build a better Healthcare System. This is the duality of the intricate complexity of the nation at Healthcare System and simple outcomes but everyone is working toward. Today i want to focus on a temple frame on our complex system. When it orients our discussion on where we want the future of healthcare reform to go. I want to talk about how we improve the access, quality and affordability of the nations Healthcare System and highlight how leaders in washington, the nations businesses and the American People can maintain the progress. First, access. In november of last year our uninsured rate had dropped below 9 . The lowest it had ever been. Between 2010 and the First Quarter of 2017, the uninsured rate fell from 16 to 8. 8 . That is historic progress, the largest decline in uninsured since the launch of medicare and medicaid but it still leaves more than 28 million americans uninsured. Connecting these people with coverage is the problem of will, not strategy. We know how to maintain the progress we have made and move forward. Nearly half of uninsured adults a cost of coverage is prohibitive. Our nation can take steps to help them. We need to actively get the message that coverage is available especially in communities where those messages dont often reach. We also need to raise awareness and Financial Assistance for people who shop on the marketplace and make sure more people no Financial Assistance that is there today is available. Last year eight of every ten people shopping on the marketplace qualified for financial help. Most could find a plan somewhere between 50, and 100 per month. More awareness and more assistance will lead to more enrollees and therefore more access which reminds me for old time sake, it is about to be november 1st, the start of open enrollment, encourage your friends, family and random twitter and facebook followers to go to healthcare. Gov or call 31825596 and for those who are spanish speakers shop around, just have to. Old habits die hard. The affordability of our Healthcare System is intricately tied to people getting coverage. Since the law passed the share of americans who cant afford it has fallen by more than one third but affordability hasnt improved for just the newly insured or the 157 million americans who have Health Insurance through their employer, family premiums have grown at an average rate of 4. 5 since 2010, down from an average of 8 over the previous decade. Affordably extends what taxpayers spend as well. Medicare spends 473 billion on personal healthcare expenditures between 2009, and 2014 thanks to the lower rate. In the context of the budget conversations going on, thinking of that 473 billion number can put it in context. Finally the third way we can measure our progress is quality. Hospital required conditions like adverse drug events, infections and pressure ulcers, declined by 21 between 2010, and 2015 and by linking those accomplishments to mortality statistics, that decline prevented 124,000 deaths. Most healthcare plans in the individual market didnt cover maternity. A third didnt cover Mental Health and almost one in ten did not discover prescription drugs and under the aca there is coverage and while the law is imperfect and there are many ways it can be improved and changes will make it better, there are some benefits that are reality and a very clear and simple reality for many American Families. Another reality is the direction our Healthcare System is moving but we often talk about the reform separately from discussions of the aca. It is important to reflect that it was a part of the act. The most important changes and models we are using to move forward on affordability and quality come from provisions in the aca like the center for medicare and Medicaid Innovation and the ability to supportable Accountable Care organizations. They also stem from other laws like the medicare access and reauthorization act. Didnt need to say that here. Macro would have done, which was passed with overwhelming bipartisan support. These changes are part of and support the change that is occurring throughout our entire Health Care System. Our Healthcare System is undergoing what i believe is a historic change. Many of you are well versed in these undercurrents of change. The research their implications, you have advocated for them. Some even helped set the policy to clear the path for them. Whatever your perspective in this room is great is clear the nations Healthcare Delivery system is entering into a new era. We developed a 3part strategy to support our Healthcare System in making progress. First, change the way we pay for care so that payers are rewarded for the quality of care rather than the quantity of services. Second, change the way we deliver care by promoting coordination and prioritizing wellness and prevention. And third, unlock healthcare data and information so doctors can make the most informed decisions and patients can be active participants in their own care. We implemented the strategy with a simple philosophy where if we needed to lead we would lead and need to convene stakeholders we would convene the man where we need to get out of the way get out of the way. At hhs we committed to 50 of medicare payments, those who valuebased contract by 2018 and when we left we were ahead of schedule. At the same time commercial insurers were venturing into valuebased payments on their own. In january 2016 we estimated a quarter of all healthcare spending would end alternative payment models. The Delivery SystemReform Movement crosses ideologies. Our administration advocated for it and democrats and republicans like my predecessor who started some of these efforts, former secretary mike leavitt and former senator bill frist. A few of my colleagues recently wrote in a new england journal of medicine piece last week the Delivery System reform effort is what i call, quote, and empirical learning approach to help reform, based on experiments, evidence and careful observation and learning. It is essential for this empirical approach to continue to meet the nonpartisan goals of better care, smarter spending and healthier people. Delivery system reform requires persistence and im hopeful this new Administration Settles in fable see the same value an alternative payment models that we did. It is an opportunity leaders from both parties have recognized. It will be important to keep moving forward, supporting p