Hello, Iowa City!  Thank you Secretary Sebelius for that introduction, and for all the amazing and tireless work you’ve done to make health care reform a reality.

I also feel your pain.  In my bracket, I had Kansas winning the entire championship, so I’m a little bit bitter too.  But I want to congratulate all the Northern Iowa fans in this part of the state on their big win.

I also want to start off by telling the folks here how inspired I’ve been by your continued resilience in the wake of the floods that devastated this region a few years back.  I know the rebuilding has been difficult, but you should know that you always have a committed partner in this Administration to support you on the road to recovery.

It is so good to be back in the great state of Iowa.  This is the state that believed in our campaign when all the pundits had written us off.  This is the state that inspired us to keep going, even when the path was uncertain.  And because of you, this is the place where change began.

Three years ago, I came here to make a promise.  Just a few months into our campaign, I stood at the University of Iowa hospital right around the corner and promised that by the end of my first term in office, I would sign a health insurance reform bill.

On Tuesday, after a year of debate and a century of trying, after so many of you shared your stories and your heartaches and your hopes, that promise was finally fulfilled.  And today, health insurance reform is the law of the land.

Just like the campaign that led us here, this historic change did not begin in Washington.  It began in places just like this, with Americans just like you.

It began when people had the courage to stand up at town hall meetings and talk about how insurance companies were denying their families coverage because of a pre-existing condition.

It began when folks wrote letters about how premium hikes of 40% and 50% and 100% were forcing them to give up their insurance.

It began when countless small business owners and families and doctors shared stories about a health care system that works better for the insurance industry than it does for the American people.

And now, this is your victory.  Because when the special interests sent an army of lobbyists to Congress and blanketed the airwaves with millions in negative ads, you mobilized and organized and refused to give up.  When the pundits were obsessing over who was up and who was down, you never lost sight of what was right and what was wrong.  You knew this wasn’t about the fortunes of any one party -- this was about the future of our country.  And today, because of what you did, that future looks stronger and more hopeful than it has in some time.

Over the last year, there’s been a lot of misinformation spread about health care reform. There has been plenty of fear-mongering and overheated rhetoric.  And if you turn on the news, you’ll see that those same folks are still shouting about how the world will end because we passed this bill.  This is not an exaggeration. Leaders of the Republican Party have actually been calling the passage of this bill “Armageddon.”

But from this day forward, all of the cynics and the naysayers will have to finally confront the reality of what this reform is and what it isn’t.

They will have to finally acknowledge that this isn’t a government takeover of our health care system.  They will see that if Americans like their doctor, they will keep their doctor.  If people like their plan, they will keep their plan.  No one will be able to take that away from you.

What this reform does is build on the system of private health insurance that we already have.  Will it solve every health care problem we have?  No.  But it finally tells the insurance companies that in exchange for all the new customers they’re about to get, they have to start playing by a new set of rules that treat everyone fairly and honestly.  The days of the insurance industry running roughshod over the American people are over.

And so if you already have insurance, this reform will make it more secure and more affordable. If you can’t afford insurance right now or have been denied coverage, you’ll finally be able to get it.  And costs will come down for families, businesses, and the federal government, reducing our deficit by more than $1 trillion over the next two decades.  That’s what reform will do.

Now, it will take about four years to implement this entire plan – because we need to do it responsibly and we need to get it right.  That means that health care costs won’t go down overnight.  But we have built into the law all sorts of measures to assure that in years to come, health care inflation, which has been rising about three times as fast as people’s wages, will start slowing.  We’ll start reducing the waste in the system, from unnecessary tests to unwarranted insurance subsidies.  So over time, Americans will save money.

Meanwhile, there are a set of reforms that will take effect this year.  This year, millions of small business owners will be eligible for tax credits that will help them cover the cost of insurance for their employees.  And let me talk about what this means for a business like your own Prairie Lights Bookstore downtown.  This is a small business that’s been offering coverage to their full-time employees for the last twenty years.  Last year their premiums went up 35%, which made it a lot harder for them to offer the same coverage.  On Tuesday, I was joined at the bill signing by Ryan Smith, who runs a small business with five employees.  His premiums are going up too, and he’s worried he’ll have to stop offering health insurance to his workers.

Starting now, small business owners like Ryan and the folks at Prairie Lights will have the security of knowing that they could qualify for a tax credit that covers up to 35% of their employees’ health insurance.  Starting today, small business owners can sit down at the end of the week, look at their expenses, and begin calculating how much money they’re going to save. And maybe they can even use that savings to hire that extra employee they’ve needed.  This health care tax credit is pro-jobs, it’s pro-business, and it starts this year.

Starting this year, tens of thousands of uninsured Americans with a preexisting condition and parents whose children have a pre-existing condition will finally be able to purchase the coverage they need.  On Tuesday, I met David Gallagher, whose daughter Lauren had written me a letter last year.  When Lauren’s mom lost her job, their entire family lost their health insurance. When they tried to get new insurance, David was denied coverage because he once had a complication-free hernia surgery.  Lauren’s been worried sick about what would happen if her father became ill or injured.  But now, because of this reform, David Gallagher can finally have access to health insurance again.  That starts this year.

This year, insurance companies will no longer be able to drop people’s coverage when they get sick; or place lifetime limits or restrictive annual limits on the amount of care they can receive.

This year, all new insurance plans will be required to offer free preventive care.

For all the students here today, starting this year, if you don’t have insurance, all new plans and some current ones will allow you to stay on your parents’ insurance policy until you’re 26 years old.  Because as you start your lives and your careers, the last thing you should worry about is whether you’ll go broke just because you get sick.

And this year, seniors who fall in the coverage gap known as the doughnut hole will receive $250 to help pay for prescriptions, which will be the first step toward closing that gap completely.  And I want seniors to know: despite what some have said, these reforms will not cut your guaranteed benefits.  In fact, under this law, Americans on Medicare will receive free preventive care, without co-payments or deductibles.  Darlyne Neff is here today.  She’s a breast cancer survivor, and she has fought her heart out for reform over the last few years. Today, the preventive care she needs will finally be covered without any charge. That’s what reform will do.

Once this reform is implemented, health insurance exchanges will be created, a competitive marketplace where uninsured people and small businesses will finally be able to purchase affordable, quality insurance.  That will happen in the next few years.  And when this exchange is up and running, millions of people will get tax breaks to help them afford coverage – credits that add up to the largest middle class tax cut for health care in history.
This is the reform that some folks in Washington are still hollering about.  And now that it’s passed, they’re already promising to repeal it.  They’re actually going to run on a platform of repeal in November.

Well I say go for it.  If these Congressmen in Washington want to come here to Iowa and tell small business owners that they plan to take away their tax credits and essentially raise their taxes, be my guest.  If they want to look Lauren Gallagher in the eye and tell her they plan to take away her father’s health insurance, that’s their right.  If they want to make Darlyne Neff pay more money for her check-ups and her mammograms, they can run on that platform.  If they want to have that fight, I welcome that fight.  Because I don’t believe the American people are going to put the insurance industry back in the driver’s seat. We’ve been there already and we’re not going back.  This country is ready to move forward.

Iowa, the road to this victory has been long and it has been difficult.  It is a struggle that many brave Americans have waged for years.  For others, like our friend Ted Kennedy, it is a struggle that was waged for nearly a lifetime.

But what this struggle has taught us – about ourselves and about this country – is so much bigger than any one issue.  It has reminded us of what we learned all those months ago on a cold January night here in Iowa:  that change, while never easy, is always possible.  That it comes not from the halls of power, but from the hearts of our people.  Amid setbacks, it requires perseverance.  Amid calls for delay, it requires a sense of urgency.  And in the face of unrelenting cynicism, it requires unyielding hope.

When I came here three years ago, I told the story of when Lyndon Johnson stood with Harry Truman and signed Medicare into law.  And as he looked out over the crowd in Independence, Missouri that day, he said, “History shapes men, but it is a necessary faith of leadership that men can help shape history.”

What this generation has proven today is that we still have it within our power to shape history.  In the United States of America, it is still a necessary faith that our destiny will be written by us, not for us.  Our future is still what we make of it.

This is not the end of difficult times for America.  From creating jobs to reducing the deficit to giving every child a decent education, we still face enormous challenges in this country.  And as we meet those challenges, we will face more resistance.  We will face more doubt and more cynicism.  We will hear more voices who will warn us that we are reaching too far and too fast; who will tell us that we can’t.

But when we do, let us remember the promise we have fulfilled, the people who fulfilled it, and the generations before us who made it possible; and let us respond with the creed that continues to define the character of this country we love:  Yes, we can.

Thank you, Iowa, God bless you, and may God bless the United States of America.