PELOSI — Transcript of House Democratic Leadership Conference Call on Affordable Care Act

January 2, 2017

Contact: Drew Hammill/Caroline Behringer 202-226-7616

Transcript of House Democratic Leadership Conference Call on Affordable Care Act

Washington, D.C. - Democratic Leader Nancy Pelosi and House Democratic leaders held a conference call today to discuss the Affordable Care Act's success in bringing down costs, increasing access, improving quality and expanding consumer protections to millions of Americans. Below are the Leader's opening and closing remarks, followed by the question and answer session:

Leader Pelosi's Opening Remarks:

"Good afternoon, everyone. For those still in the West Coast, it's still morning. Thank you so much for joining us. I'm pleased to be on this call with Democratic Whip Steny Hoyer, our Ranking Member on Ways and Means Richard Neal, Ranking Member on Energy and Commerce Frank Pallone and Ranking Member on Education Workforce Bobby Scott. We're here to talk about opening day tomorrow, and as you all know, our Republican colleagues have said they're going to launch their assault on the Affordable Care Act, and in doing so, it will be an assault on the Affordable Care Act, on Medicare, and Medicaid.

"I just, for a few opening remarks, want to say that the purpose of the Affordable Care Act was to lower costs, to improve benefits and to increase access. The ACA has made transformational progress in doing all three. This is not just about the 20 million previously uninsured Americans who now have health security, but that would be good justification - but this is about the 75 percent of the American people who get their health benefits through their workplace, not through the ACA, but who gets increased benefits through the Affordable Care Act. Whether it's relating to protections against discrimination for pre-existing conditions - being a woman is no longer a pre-existing condition - no annual lifetime or annual limits, that young people can stay on their parents' policies up to 26 years old. The list goes on and on.

"The impact on that 75 percent is also significant in terms of controlling the increase in costs which was so dramatic before the ACA and has drastically been reduced. The Republicans know that, and that's why in the Rules package, they admit that by repealing the ACA, it will increase costs - again, violating their own rule that establishes a point of order against their own bill that has a net effect of increasing direct spending by repealing the ACA.

"So, for these and other reasons, and the most important ones are what it means in the lives of the American people. My own constituent, 44 years old, left his work to start a new business. In the course of that In the course of that, he [experienced] chest pain, was taken for surgery. And the total charges were more than $133,000. Under the ACA, his co-pay was $1,470. Without the ACA, he would have had to sell his home, abandon his work to pay for his medical bills for a long time to come - a business that now employs other people.

"So, there are many more stories like Bill's. and, you know, again, what this means in the lives of the American people - if you have a child with a pre-existing condition or you become sick, whatever your circumstance is, you are health-wise and financially better off with the ACA. With that, I'm pleased to yield to our distinguished Whip, Mr. Hoyer."

Leader Pelosi's Closing Remarks:

"Thank you very much, Bobby. Thank you, my colleagues. Thank you, Mr. Hoyer. We're now ready to take questions, but I did want to thank my colleagues for the clarity with which they made their presentations, their understanding of this issue in formulating the Affordable Care Act, its implementation, and now the fight to preserve it.

"I just want to make one point to emphasize what this does to Medicare. We in the Affordable Care Act extended the life of the solvency of Medicare for many more years. We closed the donut hole, lowering the cost of prescription drugs to seniors - free annual check-up gets seniors in the loop earlier. It's almost an act of prevention, and again, the expansion of Medicaid for all the reasons that my colleagues mentioned. So, an assault on the Affordable Care Act is an assault on Medicare and Medicaid as well.

"With that, we'd be pleased, operator, to take any questions from our participants."

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Q: Hi and thank you very much for doing this. In showcasing Obamacare and your efforts to prevent the repeal - and showcasing it the day before Congress convenes - are you saying that that's your very top priority for Democrats for 2017? And if so, how do you rank other things like Republican attempts to repeal regulations and also legislation that is probably going to evolve on - in response to Russia's hacking?

Leader Pelosi. Thank you, Richie. I'll start and then yield to my colleagues, as well. The reason that we are focusing on the Affordable Care Act today is because the Republicans have said that this is their first order of business - an assault on the Affordable Care Act, on the good health of the American people.

We would hope that we could've joined together on the strong jobs initiative to promote growth, to create jobs - increasing the paychecks of the American people - and that's what we're calling on our Republican colleagues to join us in, perhaps in an infrastructure bill and other initiatives. But since they have made this assault, and they have done so in way that affects the rule that we will take up in the first order of business tomorrow. In that rule, they really admit that by repealing the Affordable Care Act, you will increase costs. And that is why they have violated their own principal of point of order against anything that increases costs, having a special vote.

So, it's the initiatives that they have taken. Yes, they will try to repeal regulations, and again, we will be there to make the fight for clean air, clean water and the rest. And the Russian hacking action that they have made no initiative on but that we are calling for an outside, independent commission to look into. And of course, also to do something internally.

So those are all important. It's important for us to fight there, depending on what regulations they want to repeal, but if it's to poison the air and water that our children drink and breathe, then we will fight that. But the reason we're talking about the Affordable Care Act right now is because rather than what we'd rather be talking about which is job creation, growth in our economy - create jobs, reduce the deficit, increase paychecks - that's what we should be talking about. Steny and others?

Whip Hoyer. Well I think the Leader is absolutely correct. The Republicans have made their chief priority repealing a bill that will affect, literally, scores of millions - as Bobby Scott pointed out, and Richard Neal and Frank Pallone - many more than the 20 million that we talk about as being direct recipients. It will affect millions of millions of millions of families across the country. And the Republicans have made that a top priority. We believe this was a very essential piece of legislation that was passed to the benefit of all Americans, including those who have employer-based insurance. Fact is that we should've been working for the last six years to make sure that it works as best as it possibly can because healthcare coverage is not an option for all Americans. So, yes it's a priority for us from that perspective. There are many other priorities, of course, which the Leader just mentioned, and which we will pay attention to as well.

Congressman Neal. This is Rich Neal. Just one observation: I think that Medicare, the ACA and Medicaid are now wed. And you can't alter one without disrupting the others. And I think that this takes us to the path that we've all envisioned - and that's universal healthcare.

Q: Hi, good afternoon. The arguments that you're all making today in favor of the benefits of the Affordable Care Act and the downside to repealing it are basically the same case that you've been making since this was a bill in 2009. And given that the incoming president and the Republican leaders in Congress seem to be hell-bent on doing away with this thing, is there a reason that you think that you'll be able to break through to the American people in a way that you've failed to do so in the, you know, last six years in the next month that could stop or delay or influence the direction of what the majority is going to do?

Leader Pelosi. Well, so there is an assault on it. In other words, I would say that if there is one thing I would've done differently about the Affordable Care Act right from the start was to message it in a much stronger way, to recognize the poisoning of the well that the Republicans were doing. The fact is though that many people are now enjoying the benefits of it - not only as - Richie and others have said - the 20 million who are additional who have insurance, who didn't have it before, but the 75 percent of the American people who receive their benefits in the workplace and their benefits package has improved, their cost rate of increase has been lowered and the impact - as Richie said - on Medicare and Medicaid and the ACA are wedded.

So right now, because of the fear that is being instilled by the Republicans, it is necessary for us to make that fight. I would just say to the American people: take a second look, take a second look.

Congressman Pallone. This is Frank Pallone. When I remember six years ago, this was all ideological with the Republicans. You know, they had the town meetings. They came in and said, "You're all these west wing, you know, liberal nuts - government control of healthcare." I think that the reality is that people, now that they have these programs - whether they're on the exchange or they have expanded Medicaid or they have employer-sponsored care, and they realize they have a good benefits package, I think they now realize that, you know, realistically from a practical point of view, that this is a good thing, that this is a positive thing for them. And so I think what we have to do, Jeff, is say, "Look. Forget this ideological battle that the Republicans have been playing for the last six years. Look at what this actually does to help you." And if you think that that's an improvement to your life - which I think it is for almost everyone - then I think it's going to be harder for the Republicans to repeal it.

So, my appeal to them, again, is: forget the ideology, look at this practically. Your ideological vent is a lot of nonsense. This is something that works. And if you take it away, people are not going to have good coverage, they're not going to have any coverage in some cases, their costs are going to increase. So I think: look at it practically. Is it different from, maybe, six years ago?

Whip Hoyer. Jeff, this is Steny. Let me make three quick points: A, we are defending a policy that over 2.8 million more Americans supported the candidate who wanted to support it than support the candidate who won. That does not mean the candidate didn't win. It doesn't mean that Trump's not going to be president, but it does mean that more Americans voted for this policy than voted against it in the persons of Trump and Clinton. [B], there was an interesting story that was written - I think it was about a Kentucky community that voted like 80 percent for Trump - and they interviewed a number of people and one woman in particular said, "Oh, I don't expect anybody to repeal the Affordable Care Act. I'm on that Act, and it's absolutely essential for me and my family."

So, I think that in our defense, I think a lot of people are going to be looking at this and saying, "Gee, I really didn't mean that" - any more than they'd want to see Social Security and Medicare privatized or voucherized. They may have voted for Trump, but if they try to do either one of those things, they're going to say to themselves, "That's not what I meant." That's exactly what happened in 1995 as Gingrich and company shut down the government - the American people said, "That's not what I meant." And after that, we picked up seats, as you recall. So, we're defending the policy that we believe the majority of the American public believes is an important benefit for them and their families to make America stronger and their families stronger.

Congressman Scott. This is Bobby Scott. I think one of the things that we need to consider - and this is if the previous attempts to repeal were not serious - that everybody knew that if anything passed Congress, the president would veto it. But now I think we have an obligation to point out to people that there is in fact replacement for the Affordable Care Act if it is repealed. People need to be aware of the benefits they will lose if it is repealed. 30 million people losing their insurance - and if you're not one of them, your rates are going to go up because of uncompensated care, you're going to lose your consumer protections, you'll lose your ability to get insurance with a pre-existing condition. A lot of people are in what is called "job lock" where they can't leave their job because they wouldn't be able to get new insurance somewhere else to cover their pre-existing conditions. There are a lot of people who have a direct interest in keeping it and what we're pointing out now is that there is no plan to replace it, just to repeal it.

Leader Pelosi. There's no question that people react more from fear of what might be taken away then they do for something that is a prospect of a good thing coming their way. Now, they have had the Affordable Care Act and all the benefits that our colleagues have gone into and how it impacts most Medicare and Medicaid in addition to that. And these families - whatever their politics - know that, personally, they will pay more for less if they have any health insurance at all. And we just need your help to get that message out to the public because this is a very serious assault on their - not only their health stability, but their financial stability. Next question?

Q: Hi. Thank you so much for taking my question. As part of the reconciliation process, which, you know, we're moving into the next couple of weeks, do you expect amendments on other policy areas, specifically the Environment and Energy?

Leader Pelosi. I think in the first reconciliation bill, it will be all about the ACA. Of course, we are not the first people you would ask about what they want to have in the reconciliation process, but everything we see them preparing for is about the ACA. Our colleagues, though, can tell you what they anticipate beyond the reconciliation because they already have a read in their committees. Richie and Frank and Bobby did you want to say what we've discussed already what you anticipate from them?

Congressman Neal. This is Rich, and they are talking about tax reform. And they did put out an election document that was very difficult to decipher but that seems to be the order that they're talking about.

Congressman Pallone. Frank Pallone. I mean, as far as the energy and environment from what I can see, they're going to do whatever they can to repeal regulations - either by legislative action or by administrative action through the president - to eliminate the clean power plan and essentially try to eliminate as much as possible any action that the President has taken to address climate change, greenhouse gases. I mean, again, this is all through the President[-elect's] tweets and what we hear through the media. The only thing that I've specifically been told about reconciliation. And Energy and Commerce Chairman Walden has told us, we will take up the instructions the week of January 30th. But as Nancy said, that was strictly with regards to the Aca and health care, not on energy or environmental issues.

Congressman Scott. This is Bobby Scott. The only thing we've heard about is rollbacks in worker protections, regulations and some executive orders. But in terms of reconciliation, we haven't heard anything other than the Affordable Care Act and we're not sure if our committee will have jurisdiction over any of the reconciliation instructions.

Leader Pelosi. Thank you. Thank you, Ryan. Any other questions?

Q: Hi, thank you for taking my question. I know right now one of the leading strategies from your Republican colleagues is this idea of repeal and delay where they would have a repeal plan and then do a replacement a few years later. I'm curious if you could speak to if they use that strategy if you could see House Democrats working with them on the eventual replacement or if once they do a repeal on their own, it makes it difficult to kind of work on any replacement together?

Leader Pelosi. Well, the ball is in their court. The fact is: is that on any legislation of this magnitude, we're always welcome to any suggestions people may have on implementation, especially after engaging in implementation for a few years. But the fact is: is that much of what is in the bill are Republican ideas: the individual mandate was a Republican idea - that was Mitt Romney, Massachusetts, 'no free riders'. Remember he said that repeatedly 'No free riders,' we have to have an individual mandate. Now they say they don't want an individual mandate. So, there remains to be seen what they have to say but the fact is: it's the old thing of going into a china shop: you break it you own it. And they're dealing with something that's very - when I say complex, it's sophisticated in terms of you have to pay meticulous attention to the detail of the provisions so that they have the impact that they have to increase access, to improve quality and to lower cost.

And so, they have shown nothing in their ranting and raving that shows any level of knowledge of where they would go, where they would take this except to say: if you need a subsidy and you're part of the exchanges, you're off. And they say that they want to keep preexisting condition provision. Well, if you have that without the rest of the bill, you will have a very big, expensive policy that you probably can't afford. That's why people didn't have it before because they couldn't afford it before. So, I think that they will learn a lot as they try to go down this path. [As] there suggestions that people have for any legislation, we're always open to that. But we'll be accomplices in the dismantling of the health and economic security of the American people" No.

Anything else, my colleagues?

Congressman Scott. This is Bobby Scott. One of the things that I think is important to note is that the Republicans have shown no interest in comprehensive health care reform since we started working on the Affordable Care Act. They offered no credible plan to replace it. They have misrepresented what's in the Affordable Care Act. They've used it as a political weapon. They've even - you have Republican state officials who have refused to take free federal money for Medicaid expansion for political purposes. I mean, there is no indication that they have any interest in doing anything. And so, I think without any credible plan, it's just not there. I would hope that the public would not accept this idea that you repeal and then get around later to replace it many years later. The fact of the matter is, once you have enacted the legislation, the mechanics of changing over to a new system take time. So, if you repeal it today effective two years from now, the insurance companies won't have time - even if they passed it tomorrow afternoon - wouldn't have time to adjust in terms of pricing, in terms of administration. They just wouldn't have time to do it. So, the idea that you can repeal and then some promise to replace when there's no indication that there's any interest in replacement I just don't think is far to the American public.

Congressman Pallone. Well, Bobby, we have to keep their feet to the fire as far as you know, our role. Because my fear is - and I think this is what Nancy was getting at is that if they simply repeal and delay - I'm being really cynical here - they're just going to hope that things fall apart because they know that things are very strong right now. More and more people have signed up. Everything has been improving. The public is very much aware of the positive aspects of the ACA. But if they repeal it and they delay it, then, you know, insurance companies may start to pull out, they'll try to suggest we go back to these skeletal plans again. And my fear is that we have to constantly point out that this repeal and delay is not acceptable because I think the purpose of it may be: well, let's just wait and you know, think that things will now fall apart, then come back later and say 'Well, it's not working and so, therefore, we have to put in something very different that doesn't have the benefits that costs a lot more.' And they'll just mask what's happening, you know, by saying, 'Well, that's not our fault.' You can look at this very cynical in terms of repeal and delay. I agree with you that it's not an acceptable alternative, but that seems to be what they're hell-bent on.

Congressman Neal. This is Rich. Just on the mechanics of reconciliation, we call the contrast in the way that we handled the Part B benefit - prescription side - we opposed it on our side largely because of the donut hole, which meant you had to spend extra dollars before the benefit kicked in. We corrected that in the ACA and moved in. Now we accept Part D and nobody complains about it. It works well. But we improved it. And I think that speaks to the question that you raised.

Whip Hoyer. Let me add that it's a very cynical, political approach - repeal and delay. It's essentially an admission that what they've been trying to do for the last six years would be very detrimental and would have not only an extraordinarily adverse health effect on the American people, but also a very adverse political effect when the American people see the results of the repeal. So what they are cynically saying is either after the 2018 election or after the 2020 election, will then have it go into effect so they do not have to bear the political responsibility of the consequences of their Act. I think it's a very politically cynical strategy on their part and an absolute admission that they have no alternative.

Leader Pelosi. If I may just agree with Steny and my colleagues: the repeal and delay is an act of cowardice on the part of Republicans. First of all, they know - as Steny pointed out - the political as well as policy downside of replacing immediately. Second of all, where are they going to get the votes to replace" If in fact ideologically they are opposed to a public role in any participation in the good health of the American people, where are they going to get the votes unless we were to act in a bipartisan way" Which means they would have to subscribe to the basic principles. The other part of that is that this is a free market solution, so they're going to have to be honest with the American people. You hear them in campaigns saying, "This is like Canada." This is nothing like Canada. This is not the delivery of service - and this isn't even single-payer. This is a free market solution. If they want to inject total uncertainty into the free market of access to healthcare coverage, they can say, "Repeal and delay." And what does that say" My colleagues pointed out some of the consequences that the insurance companies may have to take certain actions in light of the uncertainty.

So, this "repeal and delay" - the only thing it has going for it is alliteration. Apart from that, it's an act of cowardice, an act of not understanding the needs of the American people, how important the subject of cost is as it relates to care, and they are just being political in trying to defeat something, which if left to their own devices and the American people were to make a judgement about what it meant in their lives, that they would come down in favor of the Affordable Care Act, as Steny, our distinguished Whip, gave that example.

So, "repeal and delay," it doesn't even have alliteration. It doesn't even have that. It has nothing going for it. So it's an admission that there's a lot to lose for them politically, that the American people have a lot to lose from the standpoint of their coverage. And again, the reason they can't make a proposal is because they don't have the votes.

Now let me just make this one point: this is all within the context of the Republicans not really supporting Medicare in the first place. Let's go back a few decades. They didn't support Medicare in the first place. They didn't like a public participation. Now, the public is saying, "Keep your hands - government, keep your hands off my Medicare." Well, yeah, but government is a part of their Medicare. And government now wants to not only put their hands on their Medicare but to destroy the guarantee that Medicare is to seniors.

This isn't about what we're saying, this is about what they're saying in their budget. So, in their budget, they have the voucherizing of Medicare, they take $800 billion dollars of savings from Medicare, which we use to prolong the life, close the donut hole and provide more benefits for seniors. They take that and give it as a tax break to the wealthiest people in our country. So, understand the philosophy that is at work here. And understand that "repeal and delay," again, is an act of cowardice and they don't even have the votes to do it.

Thank you.