Now, this fight wasn’t new for the ANA.  I understand you were one of the only major health care organizations that supported the creation of Medicare from the start.  (Applause.)    And I want to recognize one of your leaders -– Jo Eleanor Elliott of Colorado, who is here today and was your president back then –- for the courage and leadership she showed.  (Applause.)   Where is she?  There you are right there.  Give her a big round of applause.  (Applause.)

So you’ve been there before and you were here this time.  And I want to thank the ANA for advocating（提倡，主张） for health care reform –- for ensuring that the voices of nurses and of patients were heard.

Now, already, we’re seeing the start of a profound（深远的，渊博的） shift as reforms begin to take effect.  We’re giving ordinary consumers and small businesses more power and protection in the health care system -– and we’re knocking down barriers that stand between you and the people who you care for.

A few weeks ago, 4 million small business owners and organizations got a postcard in their mailbox from the IRS.  Now, usually that's not good news.  (Laughter.)  But this time it was because it told them that they could be eligible¹ for（有资格的） a health care tax cut this year -- a tax cut worth potentially tens of thousands of dollars for those small businesses; a tax cut that will help millions to provide coverage² to their employees.  That's happening now.

In many cases, young adults without health insurance are now able to stay on their parents’ plan until they’re 26 years old.  (Applause.)  Even though insurance companies had until September to comply with this rule, we asked them to do so immediately to avoid coverage gaps for young adults, and most have agreed.

Starting this month, relief is also available to businesses for providing coverage to retirees（退休人员） who are not yet eligible for Medicare.  And as of last week, senior citizens who fall into the doughnut hole have started receiving a $250 rebate³ to help them afford their medication -- and we’re going to keep on going until we close that doughnut hole completely.  (Applause.)  In the meantime, we’re strengthening Medicare by going after the billions of dollars in waste and fraud and abuse in the system.  And states like Maine and Connecticut are beginning to predict budget savings⁴ as pieces of reform come online.

So we’ve begun making coverage more affordable⁵.  In addition, the new health care law has also started to end the worst insurance industry practices.  You know them.  For too long, we’ve been held hostage to an industry that jacks⁶ up（顶起，提高） premiums⁸ and drops coverage whenever they please.  Those days are coming to an end.  (Applause.)

So after my administration demanded that a large insurance company justify⁹ a massive premium⁷ increase on Californians, the company backed off its plan.  My Secretary of Health and Human Services, Kathleen Sebelius, has urged states to investigate other rate hikes.  We’ve set up a new Office of Consumer Information and Insurance Oversight¹⁰.  And we’ll provide grants to states running the best oversight programs to root out（根除，发现） bad practices when it comes to premiums.

Now, as of September, the new health care law prohibits insurance companies from dropping people’s coverage when they get sick, which is critical to giving people some peace of mind.  (Applause.)  But when news reports indicated that an insurance company was dropping the coverage of women diagnosed with breast cancer, my administration called on them to end the practice immediately -- don’t wait till September.  (Applause.)  And soon after, the entire industry announced that it would comply with the new law early and stop this perverse¹¹（不正当的，倔强的） practice of dropping people’s insurance when they fall ill and when they need coverage the most.  (Applause.)

Some were also questioning whether insurance companies could find a loophole in the new law and continue to discriminate¹² against children with preexisting conditions.  So we called on insurance companies to step up, provide coverage to our most vulnerable（有弱点的，易受伤害的） Americans.  And the insurance industry has agreed.

In just two weeks, Americans denied coverage because of preexisting conditions will be able to enroll¹³ in a new national insurance pool.  And for states that opt¹⁴ to run their own pools -- using funds from the new law -- we’re urging them to begin enrolling¹⁵ people as soon as possible.  And these pools are going to provide some short-term relief, but they're temporary.  They’re going to ensure that folks who have been shut out of the market because they’ve been sick can access more affordable insurance starting right away.  But what we want is these health insurance exchanges up and running in a few years, so that, at that point, this kind of discrimination will finally be banned forever.  (Applause.)  And that’s when those -- that's when the millions without coverage, including people with preexisting conditions, will have the access to the same types of insurance plans that members of Congress get.  And you know those must be pretty good.  (Applause.)

We’re also going to be putting in place a patient’s bill of rights that will tell insurance companies that they can’t put a restrictive limit on the amount of coverage you get in your lifetime, or in a given year.  It will prevent insurance companies from rescinding¹⁶（废除，撤回） your coverage when you get sick because of an administrative¹⁷ error.  It will provide simple and clear information to consumers about their choices and their rights.
 
And beyond making insurance more affordable and more secure, reform also will mean changes that make it easier for you -- the backbone¹⁸（决心，支柱） of the health care system -- to do your jobs.  Already, over the past year, we’ve made one of the largest investments in the nursing and health workforce¹⁹ in recent history.  (Applause.)  We passed landmark²⁰ reforms to make college more affordable, which can help more people gain a nursing degree –- even as we provide grants and aid for more than 15,000 nurses seeking graduate degrees and other training.  (Applause.)

And we’ve begun the transition to private and secure computerized health records, because this will not only reduce errors and costs -– I know you can’t read those doctors’ handwriting -- (laughter) -- it will mean you can spend more time with patients and less time with paperwork.  And that's why you got into the profession.  (Applause.)

Now, there is more work to do.  And that's why today my administration is announcing a number of investments to expand the primary care workforce.  This includes funding to allow students training part-time to become nurse practitioners²¹ to start training full-time²².  (Applause.)  We want to speed up the process where folks go from the classroom into the exam room.  And we’re going to provide resources for clinics run by registered nurses and nurse practitioners.  (Applause.)

Without these nurses, many people in cities and rural areas would have no access to care at all.  Now, all of these steps are part of a larger effort to make our system work better for nurses and for doctors, and to improve the quality of care for patients.  And by focusing on primary medicine, we will finally recognize the role of all talented and skilled health care providers –- including nurses.  (Applause.)

I don’t have to tell you that nurses all too often have been given short shrift.  Even amidst a nursing shortage, when there are cutbacks, you feel the squeeze in salaries or the reduction in shifts –- despite being overworked and underpaid.  And, as you know, this disregard goes beyond numbers on a ledger²³.  There have been a bunch of times, I’m sure, when the service you rendered is thought to be less consequential²⁴ or valuable than that of other professions.  That's what has to change.

It’s important that we not only ensure that you have the support to do your jobs -– we’re seeking to elevate and value the work that you do, because -- (applause) -- throughout our history, nurses have done more than provide care and comfort to those in need.  Often with little power or sway on their own, nurses -- mostly women, historically -– have been a force of will and a sense of common decency²⁵（正派，体面） , and paved the way towards better care and a more compassionate²⁶ society -- from Clara Barton’s treatment of wounded soldiers at Antietam, to the advocacy of Dorothea Dix on behalf of people with mental disabilities, to the countless²⁷ nurses whose names we’ll never know.

One of America’s greatest poets, Walt Whitman, also served as a nurse during the Civil War.  And the experience changed him forever.  Later, he would reflect on that time, on both the heartbreak and the fulfillment he found during those years.  And he wrote:

I thread my way through the hospitals,
The hurt and wounded I pacify²⁸（安慰，平定） with soothing²⁹ hand,
I sit by the restless all the dark night,
Some are so young, some suffer so much,
I recall the experience sweet and sad

Sweet and sad.  Your jobs are tough.  Your days can be stressful and exhausting and sometimes thankless.  But through long shifts and late nights -– in the hectic³⁰（兴奋的，狂热的） scrum（扭打，混乱） of the emergency room, or in those quiet acts of humanity -– you are saving lives, you are offering solace³¹（安慰，慰藉） , you’re helping³² to make us a better nation.  And my task as President –- our task as a people –- is to ensure that our health care system is worthy³³ of your efforts.  Our mission must be to live up to（实践，做到） the values you uphold（赞成，鼓励） each and every day.

So, thank you.  God bless you.  And God bless the United States of America.  (Applause.)  Thank you, everybody.  Thank you.  (Applause.)

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