Full Text Political Transcripts June 13, 2017: President Donald Trump’s Remarks on Healthcare

POLITICAL TRANSCRIPTS

TRUMP PRESIDENCY & 115TH CONGRESS:

Remarks by President Trump on Healthcare

Source: WH, 6-13-17

General Mitchell International Airport
Milwaukee, Wisconsin

3:14 P.M. CDT

THE PRESIDENT:  Thank you.  Thank you, everybody.  Thank you very much.

Millions of American families — and I mean millions — continue to suffer from Obamacare while congressional Democrats obstruct our efforts to rescue them.  And I’ll tell you, that’s exactly what’s happening.  The Democrats have let you down, big league.  Standing beside me are two such families, representing so many others — millions of people — who have been victimized by Obamacare — terrible law.

My thanks to Michael and Tammy Kushman from Marinette County, and Robert and Sarah Stoll from Kenosha, as well as their wonderful families, for joining us today.  We appreciate it.  We appreciate all the people being here.  Thank you, folks.  (Applause.)  They love their country, play by the rules, and work hard to give their loved ones the best life possible.

Michael Kushman is a proud veteran of the United States Army Medical Service Core.  He and his wife Tammy were forced onto the Obamacare exchange in 2015 — and like countless others, they were shocked to learn that they couldn’t keep their doctor as promised.   They couldn’t keep their plan as promised.  They started out paying $600 per month.  Then their insurer quit the exchange, so they had to switch to a new plan, and it went up to $1,000 a month.  And it keeps going up and up and up.  And that’s where we are today.  Now it’s over $1,400 per month.  They’ve been forced off their plans and onto a new one three times in three years.  Their premiums have soared 127 percent.  The Kushmans now spend nearly one-fourth of their net monthly income on health insurance.  So — both of you, both families.  Both great families.

Robert and his wife Sarah Stoll have also endured enormous pain under the crushing burden of Obamacare.  Robert serves as a volunteer captain for the Randall Fire Department.  He was a small business owner for 30 years.  But their Obamacare premiums doubled, and Sarah was forced to leave retirement and find a part-time job just to pay the bills.  When she did so, making matters worse, their new income meant they were no longer eligible for the tax credit they had once received — and the federal government actually forced them to repay thousands of dollars.

These are sad — I agree, that’s true.  Has it happened to you also?  Yes.  Yeah, it has.  These are sad but familiar stories in Wisconsin, where Obamacare premiums have doubled.  Obamacare is one of the greatest catastrophes that our country has signed into law — and the victims are innocent, hardworking Americans like Michael and Tammy, Robert and Sarah.  These citizens deserve so much better.

The House of Representatives has passed on to the Senate, and the Senate is getting ready to do something — hopefully it will get done — where we will come up with a solution, and a really good one, to healthcare.  No matter how good it is, we will get no obstructionist Democrat votes.  No matter how good it is — if it’s the greatest healthcare plan ever devised, we will get zero votes by the obstructionists, the Democrats.  It’s time to give American families quality, reliable, affordable healthcare — and that’s what we are working very hard to do.  And we’ll get it done.

So I want to thank you, I want to thank the families — thank you very much — for being here.  And I love being in Wisconsin.  I love being in Wisconsin.  Thank you.  (Applause.)

END
3:19 P.M. CDT

Full Text Political Transcripts March 6, 2017: American Health Care Act GOP Health Care Bill

POLITICAL TRANSCRIPTS

TRUMP PRESIDENCY & 115TH CONGRESS:

Full-Text American Health Care Act

PDF

Speaker Paul Ryan’s Presentation on the American Health Care Act

Full Text Political Transcripts December 16, 2016: President Barack Obama’s last end-of-year press conference

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & 114TH CONGRESS:

President Barack Obama’s last end-of-year news conference

Source: WaPo, 12-16-16

OBAMA: All right, everybody. Good afternoon. This is the most wonderful press conference of the year. I have got a list of who has been naughty and nice to call on. But let me first make a couple of quick points and then I will take your questions.

Typically I use this year-end press conference to review how far we have come over the course of the year. Today, understandably, I’m going to talk a little bit about how far we have come over the past eight years.

As I was preparing to take office, the unemployment rate was on its way to 10 percent. Today it is at 4.6 percent, the lowest in nearly a decade. We’ve seen the longest streak of job growth on record, and wages have grown faster over the past few years than at any time in the past 40.

When I came into office, 44 million people were uninsured. Today we have covered more than 20 million of them. For the first time in our history, more than 90 percent of Americans are insured.

In fact, yesterday was the biggest day ever for health care.gov, more than 670,000 Americans signed up to get covered, and more are signing up by the day.

We’ve cut our dependence on foreign oil by more than half, doubled production of renewable energy, enacted the most sweeping reforms since FDR to protect consumers and prevent a crisis on Wall Street from punishing main street ever again.

None of these actions stifled growth as critics are predicted. Instead, the stock market has nearly tripled.

Since I signed Obamacare into law, our businesses have added more than 15 million new jobs, and the economy undoubtedly more durable than it was in the days when we relied on oil from unstable nations and banks took risky bets with your money.

Add it all up, and last year the poverty rate fell at the fastest rate in almost 50 years, while the median household income grew at the fastest rate on record. In fact, income gains were actually larger for households at the bottom and the middle than for those at the top.

And we have done all this while cutting our deficits by nearly two-thirds, and protecting vital investments that grow the middle class.

In foreign policy, when I came into office we were in the midst of two wars. Now nearly 180,000 troops are down to 15,000. Bin Laden, rather than being at large, has been taken off the battlefield, along with thousands of other terrorists.

Over the past eight years no foreign terrorist organization has successfully executed an attack on our homeland that was directed from overseas. Through diplomacy, we have ensured Iran cannot obtain a nuclear weapon without going to war with Iran.

We opened up a new chapter with the people of Cuba. And we have brought nearly 200 nations together around a climate agreement that could very well save this planet for our kids.

And almost every country on Earth sees America as stronger and more respected today than they did eight years ago. In other words, by so many measures our country is stronger and more prosperous than it was when we started. It is a situation that I’m proud to leave for my successor. And it’s thanks to the American people, to the hard work that you have put in, the sacrifices you have made for your families and your communities, the businesses that you started or invested in, and the way you looked out for one another. And I could not be prouder to be your president.

Of course, to tout this progress does not mean that we are not mindful of how much more there is to do. In this season in particular, we are reminded that there are people who are still hungry, people who are still homeless, people who still have trouble paying the bills or finding work after being laid off.

There are communities that are still mourning those who have been stolen from us by senseless gun violence, and parents who still are wondering how to protect their kids.

OBAMA: And after I leave office I intend to continue to work with organizations and citizens doing good across the country on these and other pressing issues to build on the progress that we have made.

Around the world as well, there are hotspots where disputes have been intractable, conflicts have flared up, and people, innocent people are suffering as result, and nowhere is this more terribly true than in the city of Aleppo. For years, we’ve worked to stop the civil war in Syria and alleviate human suffering. It has been one of the hardest issues that I’ve faced as president.

The world as we speak is united in horror at the savage assaults by the Syrian regime and its Russian and Iranian allies on the city of Aleppo. We have seen a deliberate strategy of surrounding, besieging and starving innocent civilians. We’ve seen relentless targeting of humanitarian workers and medical personnel, entire and neighbors reduced to rubble and dust. There are continuing reports of civilians being executed. These are all horrific violations of international law.

Responsibility for this brutality lies in one place alone, with the Assad regime and its allies, Russia and Iran, and this blood and these atrocities are on their hands. We all know what needs to happen. There needs to be an impartial international observer force in Aleppo that can help coordinate an orderly evacuation through say corridors. There has to be full access for humanitarian aid, even as the United States continues to be the world’s largest donor of humanitarian aid to the Syrian people. And beyond that, there needs to be a broader cease-fire that can serve as the basis for a political rather than a military solution.

That’s what the United States is gonna continue to push for, both with our partners and through multilateral institutions like the U.N.

Regretfully, but unsurprisingly, Russia has repeatedly blocked the Security Council from taking action on these issues, so we’re gonna keep pressing the Security Council to help improve the delivery of humanitarian aid to those who are in such desperate need and ensure accountability, including continuing to monitor any potential use of chemical weapons in Syria.

And we’re gonna work in the U.N. General Assembly as well, both on accountability and to advance a political settlement because it should be clear that although you may achieve tactical victories, over the long-term, the Assad regime cannot slaughter its way to legitimacy. That’s why we’ll continue to press for a transition to a more representative government, and that’s why the world must not avert our eyes to the terrible events that are unfolding.

The Syrian regime and its Russian and Iranian allies are trying to obfuscate the truth. The world should not be fooled and the world will not forget.

So even in a season where the incredible blessings that we know as Americans are all around us, even as we enjoy family and friends and are reminded of how lucky we are, we should also be reminded that to be an American involves bearing burdens and meeting obligations to others. American values and American ideals are what will lead the way to a safer and more prosperous 2017, both here and abroad. And by the way, you (ph) embody those values and ideals like our brave men and women in uniform and their families.

So I just want to close by wishing all of them a very merry Christmas and a happy new year.

With that, I will take some questions, and I’m gonna start with Josh Lederman of A.P.

QUESTION: Thank you, Mr. President.

There’s a perception that you’re letting President Putin get away with interfering in the U.S. election and that a response that nobody knows about (inaudible) don’t cut it. Are you prepared to call out President Putin by name for ordering (inaudible)? And do you agree with Hillary Clinton now says, that the hacking was actually partially responsible for her loss?

And is your administration open to correlate with Trump and his team on this issues, tarnishing (ph) the smooth transition of power that you have promised?

OBAMA: Well, first of all, with respect to the transition, I think they would be the first to acknowledge that we have done everything we can to make sure that they are successful, as I promised, and that will continue. And it’s just been a few days since I last talked to the president-elect about a whole range of transition issues. That cooperation’s gonna continue.

OBAMA: There hasn’t been a lot of squabbling. What we’ve simply said is the facts, which are that based on uniform intelligence assessments, the Russians were responsible for hacking the DNC and that as a consequence, it is important for us to review all elements of that and make sure that we are preventing that kind of interference through cyber attacks in the future. That should be a bipartisan issue, that shouldn’t be a partisan issue.

And my hope is that the president-elect is going to similarly be concerned with making sure that we don’t have a potential foreign influence in our election process. I don’t think any American wants that. And that shouldn’t be a source of an argument.

I think that part of the challenge is that it gets caught up in the carryover from election season. And I think it is very important for us to distinguish between the politics of the election and the need for us as a country, both from a national security perspective but also in terms of the integrity of our election system and our democracy to make sure that we don’t create a political football here.

Now, with respect to how this thing unfolded last year, let’s just go through the facts pretty quickly. At the beginning of the summer, were alerted to the possibility that the DNC has been hacked. And I made (ph) an order, law enforcement, as well as our intelligence teams to find out everything about it, investigate it thoroughly to brief the potential victims of this hacking, to brief on a bipartisan basis the leaders of both the House and the Senate and the relevant intelligence committees.

And once we had clarity and certainty around what in fact had happened, we publicly announced that in fact Russia had hacked into the DNC. And at that time, we did not attribute motives or you know any interpretations of why they had done so.

We didn’t discuss what the effects of it might be. We simply let people know — the public know just as we had let members of Congress know that this had happened.

And as a consequence, all of you wrote a lot of stories about both what had happened and then you interpreted why that might have happened and what effect it was going to have on the election outcomes. We did not — and the reason we did not was because in this hyper-partisan atmosphere, at a time when my primary concern was making sure that the integrity of the election process was not in any way damaged, at a time when anything that was said by me or anybody in the White House would immediately be seen through a partisan lens. I wanted to make sure that everybody understood we were playing this thing straight, that we weren’t trying to advantage one side or another. But what we were trying to do was let people know that this had taken place.

And so if you started seeing effects on the election, if you were trying to measure why this was happening and how you should consume the information that was being leaked, that you might want to take this into account. And that’s exactly how we should have handled it.

Imagine if we had done the opposite, it would become immediately just one more political scrum. And part of the goal here was to make sure that we did not do the work of the leakers for them by raising more and more questions about the integrity of the election right before the election was taking place — at a time, by the way, when the president-elect himself was raising questions about the integrity of the election.

And finally, I think it’s worth pointing out, that the information was already out. It was in the hands of Wikileaks, so that was going to come out no matter what.

What I was concerned about in particular was making sure that that wasn’t compounded by potential hacking that could hamper vote counting, affect the actual election process itself.

And so in early September when I saw President Putin in China, I felt that the most effective way to ensure that that did not happen was to talk to him directly and tell him to cut it out, there were going to be some serious consequences if he did not.

And in fact, we did not see further tampering of the election process. But the leaks through Wikileaks had already occurred.

So when I look back in terms of how we handled it, I think we handled it the way it should have been handled. We allowed law enforcement and the intelligence community to do its job without political influence.

We briefed all relevant parties involved in terms of what was taking place. When we had a consensus around what had happened, we announced it, not through the White House, not through me, but rather through the intelligence communities that had actually carried out these investigations.

And then we allowed you and the American public to make an assessment as to how to weigh that going into the election.

And the truth is, is that there was nobody here who did not have some sense of what kind of effect it might have. I am finding it a little curious that everybody is suddenly acting surprised that this looked like it was disadvantaging Hillary Clinton, because you guys wrote about it every day, every single leak about every little juicy tidbit of political gossip, including John Podesta’s risotto recipe.

This was an obsession that dominated the news coverage. So I do think it is worth us reflecting how it is that a presidential election of such importance, of such moment, with so many big issues at stake and such a contrast between the candidates came to be dominated by a bunch of these leaks.

What is it about our political system that made us vulnerable to these kinds of potential manipulations which, as I’ve said publicly before, were not particularly sophisticated. This was not some elaborate, complicated espionage scheme.

They hacked into some Democratic Party e-mails that contained pretty routine stuff, some of it embarrassing or uncomfortable because I suspect that if any of us got our emails hacked into there might be some things that we would not want suddenly appearing on the front page of a newspaper or a telecast, even if there was not anything particularly illegal or controversial about it.

And then it just took off. And that concerns me, and it should concern all of us. But the truth of the matter is, is that everybody had the information. It was out there, and we handled it the way we should have.

Now, moving forward, I think there are a couple of issues that this raises. Number one is just the constant challenge that we are going to have with cyber security throughout our economy and throughout our society.

We are a digitalized culture. And there’s hacking going on every single day. There is not a company, there is not a major organization, there is not a financial institution, there is not a branch of our government were somebody is not going to be fishing for something or trying to penetrate or put in a virus or malware.

And this is why for the last eight years I have been obsessed with how do we continually upgrade our cyber security systems. And this particular concern around Russian hacking is part of a broader set of concerns about how do we deal with cyber issues being used in ways that can affect our infrastructure, affect the stability of our financial systems, and affect the integrity of our institutions like our election process.

I just received, a couple of weeks back, it wasn’t widely reported on, a report from our cyber-security commission that outlines a whole range of strategies to do a better job on this. But it’s difficult because it’s not all housed — the target of cyberattacks is not one entity, but it’s widely dispersed and a lot of it is private, like the DNC. You know, it’s not a branch of government. We can’t tell people what to do.

What we can do is inform them, get best practices. What we can also do is to on a bilateral basis warn other countries against these kinds of attacks, and we’ve done that in the past. So just as I told Russia to stop it and indicated there will be consequences when they do it, the Chinese have in the past engaged in cyberattacks directed at our companies to steal trade secrets and proprietary technology, and I had to have the same conversation with President Xi. And what we’ve seen is some evidence that they have reduced but not completely eliminated these activities, partly because they can use cutouts. One of the problems with the internet and cyber issues is there’s not always a return address, and by the time you catch up to it, you know, attributing what happened to a particular government can be difficult, not always provable in court, even tough our intelligence communities can make an assessment.

What we’ve also tried to do is to start creating some international norms about this to prevent some sort of cyber arms race because we obviously have offensive capabilities as well as defensive capabilities, and my approach is not a situation which everybody’s worse off because folks are constantly attacking each other back and forth, but putting some guardrails around behavior of nation states, including our adversaries, just so that they understand that whatever they do to us, we can potentially do to them.

We do have some special challenges because oftentimes, our economy is more digitalized. It is more vulnerable partly because we’re a wealthier nation and we’re more wired than some of these other countries and we have a more open society and engage in less control and censorship over what happens over the internet, which is also part of what makes us special.

Last point, and the reason I’m going on here is because I know that you guys have a lot of questions about this and I addressed all of you directly about this. With respect to response, my principal goal leading up to the election was making sure that the election itself went off without a hitch, that it was not tarnished and that it did not feed any sense in the public that somehow, tampering had taken place with the actual process of voting and we accomplished that. That does not mean that we are not going to respond, it simply meant that we had a set of priorities leading up to the election that were of the utmost importance.

Our goal continues to be to send a clear message to Russia or others not to do this to us because we can do stuff to you, but it is also important for us to do that in a thoughtful, methodical way. Some of it, we do publicly. Some of it, we will do in a way that they know but not everybody will. And I know that there have been folks out there who suggests somehow that if we went out there and made big announcements and thumped our chests about a bunch of stuff, that somehow that would potentially spook the Russians.

But keep in mind that we already have enormous numbers of sanctions against the Russians. The relationship between us and Russia has deteriorated, sadly, significantly over the last several years. And so how we approach an appropriate response that increases costs for them for behavior like this in the future but does not create problems for us is something that’s worth taking the time to think through and figure out. And that’s exactly what we’ve done.

So, at a point in time where we’ve taken certain actions that we can divulge publicly, we will do so. There are times where the message will be directly received by the Russians and not publicized. And I should point out by the way, part of why the Russians have been effective on this is because they don’t go around announcing what they’re doing. It’s not like Putin’s gone around the world publicly saying, look what we did. Wasn’t that clever? He denies it.

So the idea that somehow public shaming is gonna be effective, I think doesn’t read the — the thought process in Russia very well. OK.

QUESTION: Did Clinton lose because of the hacking?

OBAMA: I’m gonna let all the political pundits in this town have a long discussion about what happened in the election. It was a fascinating election. So, you know, I’m sure there are gonna be a lot of books written about it. I’ve said what I think is important for the Democratic Party going forward, rather than try to parse every aspect of the election.

And I — I’ve said before, I couldn’t be prouder of Secretary Clinton, her outstanding service and she’s worked tirelessly on behalf of the American people and I don’t think she was treated fairly during the election. I think the coverage of her and the issues was troubling, but having said that, what I’ve been most focused on — appropriate for the fact I am not going to be a politician in about — what is it, 32 days, 31, 34?

(LAUGHTER)

What I’ve said is that I can maybe give some counsel advice to the Democratic Party. And I think the — the — the thing we have to spend the most time on — because it’s the thing we have most control over — is, how do we make sure that we’re showing up in places where I think Democratic policies are needed, where they are helping, where they are making a difference, but where people feel as if they’re not being heard?

And where Democrats are characterized as coastal, liberal, latte- sipping, you know, politically correct, out-of-touch folks, we have to be in those communities. And I’ve seen that, when we are in those communities, it makes a difference. That’s how I became president. I became a U.S. Senator not just because I had a strong base in Chicago, but because I was driving downstate Illinois and going to fish fries and sitting in V.F.W. Halls and talking to farmers.

And I didn’t win every one of their votes, but they got a sense of what I was talking about, what I cared about, that I was for working people, that I was for the middle class, that the reason I was interested in strengthening unions and raising the minimum wage and rebuilding our infrastructure and making sure that parents had decent childcare and family leave, was because my own family’s history wasn’t that different from theirs even if I looked a little bit different. Same thing in Iowa.

And so the question is, how do we rebuild that party as a whole, so that there’s not a county in any state — I don’t care how red — where we don’t have a presence and we’re not making the argument, because I think we have a better argument. But that requires a lot of work. You know, it’s been something that I’ve been able to do successfully in my own campaigns.

OBAMA: It is not something I’ve been able to transfer to candidates in mid-terms and sort of build a sustaining organization around. That’s something I would have liked to have done more of, but it’s kind of hard to do when you’re also dealing with a whole bunch of issues here in the White House. And that doesn’t mean, though, that it can’t be done, and I think there are gonna be a lot of talented folks out there, a lot of progressives who share my values, who are gonna be leading the charge in the years to come.

Michelle Kosinski (ph) of CNN.

QUESTION: Thank you.

This week we heard Hillary Clinton talk about how she thinks that the FBI director’s most recent announcement made a difference in the outcome of the election. And we also just heard in an op-ed her campaign chairman talk about something being deeply broken within the FBI.

He talked about thinking that the investigation early on was lackadaisical, in his words. So what do you think about those comments? Do you think there’s any truth to them? Do you think there’s a danger there that they’re calling into question the integrity of institutions in a similar way that Donald Trump’s team has done?

And the second part to that is that Donald Trump’s team repeatedly — I guess, given the indication that the investigation of the Russian hack as well as retaliation might not be such a priority once he’s in office.

So what do you think the risk is there? And are you going to talk to him directly about some of those comments he made?

OBAMA: Well, on the latter point, as I said before, the transition from election season to governance season is not always smooth. You know, it’s bumpy. There are still feelings that are raw out there. There are people who are still thinking how things unfolded. And I get all that.

But when Donald Trump takes the oath of office and is sworn in as the 45th president of the United States, then he has got a different set of responsibilities and considerations.

And I’ve said this before. I think there is a sobering process when you walk into the Oval Office. And, you know, I haven’t shared previously private conversations I’ve had with the president-elect. I will say that they have been cordial and in some cases have involved me making some pretty specific suggestions about how to ensure that regardless of our obvious deep disagreements about policy, maybe I can transmit some thoughts about maintaining the effectiveness, integrity, cohesion of the office, our various democratic institutions, and he has listened.

I can’t say that he will end up implementing, but the conversations themselves have been cordial as opposed to defensive in any way. And I will always make myself available to him just as previous presidents have made themselves available to me as issues come up.

With respect to the FBI, I will tell you, I’ve had a chance to know a lot of FBI agents. I know Director Comey. They take their job seriously. They work really hard. They help keep us safe and save a lot of lives.

And it is always a challenge for law enforcement when there’s an intersection between the work that they are doing and the political system. It’s one of the difficulties of democracy generally.

We have a system where we want our law enforcement investigators and our prosecutors to be free from politics, to be independent, to play it straight. But sometimes that involves investigations that touch on politics and particularly in this hyper-partisan environment that we’ve been in, everything is suspect, everything you do one way or the other.

One thing that I have done is to be pretty scrupulous about not wading into investigation decisions or prosecution decisions or decisions not to prosecute. I have tried to be really strict in my own behavior about preserving the independence of law enforcement, free from my own judgments and political assessments, in some cases. And I don’t know why it would stop now.

Mike Dorney (ph) of Bloomberg.

QUESTION: Thank you, Mr. President.

On Aleppo, your views of (ph) what happens there, the responsibility of the Russian government, the Iranian government, the Assad regime (inaudible), but do you, as president of the United States, leader of the free world, feel any personal moral responsibility now at the end of your presidency for the carnage we’re all watching in Aleppo, which I’m sure disturbs you (inaudible)?

Secondly, also on Aleppo, you’ve again made clear your practical disagreements with (inaudible) and President-elect Trump has throughout his campaign, and he said again last night, that he wants to create safe zones in Syria. Do you feel like in this transition, you need to help him toward implementing that or is that not something you need to be doing?

OBAMA: Mike, I always feel responsible. I felt responsible when kids were being shot by snipers. I felt responsible when millions of people had been displaced. I feel responsible for murder and slaughter that’s taken place in South Sudan that’s not being reported on, partly because there’s not as much social media being generated from there.

There are places around the world where horrible things are happening and because of my office, because I’m president of the United States, I feel responsible. I ask myself every single day, is there something I could do that would save lives and make a difference and spare some child who doesn’t deserve to suffer. So that’s a starting point. There’s not a moment during the course of this presidency where I haven’t felt some responsibility.

That’s true, by the way, for our own country. When I came into office and people were losing their jobs and losing their homes and losing their pensions, I felt responsible and I would go home at night and I would ask myself, was there something better that I could do or smarter that I could be that would make a difference in their lives, that would relieve their suffering and relieve their hardship.

So with respect to Syria, what I have consistently done is taken the best course that I can to try to end the civil war while having also to take into account the long-term national security interests of the United States. And throughout this process, based on hours of meetings — if you tallied it up, days and weeks of meetings — where we went through every option in painful detail with maps and we had our military and we had our aid agencies and we had our diplomatic teams, and sometimes, we’d bring in outsiders who were critics of ours.

OBAMA: Whenever we went through it, the challenge was that short of putting large numbers of U.S. troops on the ground uninvited, without any international law mandate, without sufficient support from Congress, at a time when we still had troops in Afghanistan and we still had troops in Iraq and we had just gone through over a decade of war and spent trillions of dollars and when the opposition on the ground was not cohesive enough to necessarily govern a country and you had a military superpower in Russia prepared to do whatever it took to keep its (inaudible) involved and you had a regional military power in Iran that saw their own vital strategic interests at stake and were willing to maintain that territory in the absence of consent from the Syrian government and now the Russians or the Iranians.

So it may be that with Aleppo’s tragic situation unfolding that in the short term, if we can get more of the tens of thousands who are still trapped there out , that so long as the world’s eyes are on them and they are feeling pressure, the regime in Russia concludes that they are willing to find some arrangement, perhaps in coordination with Turkey, whereby those people can be safe.

Even that will probably be temporary, but at least it solves a short-term issue that’s going to arise.

Unfortunately we are not there yet because right now we have Russians and Assad claiming that basically all the innocent civilians who were trapped in Aleppo are out when international organizations, humanitarian organizations who know better and who are on the ground, have said unequivocally that there are still tens of thousands who are trapped and prepared to leave under pretty much any conditions.

And so right now our biggest priority is to continue to put pressure wherever we can to try to get them out.

(CROSSTALK)

OBAMA: Mike, I can’t have too much…

QUESTION: (OFF-MIKE) but do you see, responsibility notwithstanding, moving in that direction or help President-elect Trump move in that direction?

OBAMA: I will help President Trump — President-elect Trump with any advice, counsel, information that we can provide so that he, once he’s sworn in, can make a decision.

Between now and then, these are decisions that I have to make based on the consultations that I have with our military and the people who have been working this every single day.

Peter Alexander (ph).

QUESTION: Mr. President, thank you very much.

Can you, given all the intelligence that we have now heard, assure the public this was once and for all a free and fair election? And specifically on Russia, do you feel any obligation now as they have been insisting that this isn’t the case to show the proof, as it were? They say, put your money where your mouth is and declassify some of the intelligence and the evidence that exists.

And more broadly, as it relates to Donald Trump on this very topic, are you concerned about his relationship with Vladimir Putin, especially given some of the recent cabinet picks, including his selection for secretary of state, Rex Tillerson, who toasted Putin with champagne over oil deals together? Thank you.

OBAMA: I may be getting older because these multipart questions, I start losing track.

(LAUGHTER)

OBAMA: I can assure the public that there was not the kind of tampering with the voting process that was our concern and will continue to be of concern going forward, that the votes that were cast were counted, they were counted appropriately.

We have not seen evidence of machines being tampered with, so that assurance I can provide.

That doesn’t mean that we find every single, you know, potential probe of every single voting machine all across the country, but we paid a lot of attention to it. We worked with state officials, et cetera, and we feel confident that that didn’t occur and that the votes were cast and they were counted.

And so that’s on that point. What was the second one?

QUESTION: Say more about declassification.

OBAMA: Declassification. Look, we will provide evidence that we can safely provide, that doesn’t mean, though, that it can’t be done, and I think there are going to be a lot of talented folks out there, a lot of progressives who share my values who are going to be leading the charge in the years to come.

Michelle Kosinski (ph) of CNN.

QUESTION: Thank you.

This week we heard Hillary Clinton talk about how she thinks that the FBI director’s most recent announcement made a difference in the outcome of the election. And we also just heard in an op-ed her campaign chairman talk about something being deeply broken within the FBI.

He talked about thinking that the investigation early on was lackadaisical, in his words. So what do you think about those comments? Do you think there’s any truth to them? Do you think there’s a danger there that they’re calling into question the integrity of institutions in a similar way that Donald Trump’s team has done?

And the second part to that is that Donald Trump’s team repeatedly — I guess, given the indication that the investigation of the Russian hack as well as retaliation might not be such a priority once he’s in office.

So what do you think the risk is there? And are you going to talk to him directly about some of those comments he made?

OBAMA: Well, on the latter point, as I said before, the transition from election season to governance season is not always smooth. You know, it’s bumpy. There are still feelings that are raw out there. There are people who are still thinking how things unfolded. And I get all that.

But when Donald Trump takes the oath of office and is sworn in as the 45th president of the United States, then he has got a different set of responsibilities and considerations.

And I’ve said this before. I think there is a sobering process when you walk into the Oval Office. And, you know, I haven’t shared previously private conversations I’ve had with the president-elect. I will say that they have been cordial and in some cases have involved me making some pretty specific suggestions about how to ensure that regardless of our obvious deep disagreements about policy, maybe I can transmit some thoughts about maintaining the effectiveness, integrity, cohesion of the office, our various democratic institutions, and he has listened.

I can’t say that he will end up implementing, but the conversations themselves have been cordial as opposed to defensive in any way. And I will always make myself available to him just as previous presidents have made themselves available to me as issues come up.

With respect to the FBI, I will tell you, I’ve had a chance to know a lot of FBI agents. I know Director Comey. They take their job seriously. They work really hard. They help keep us safe and save a lot of lives.

And it is always a challenge for law enforcement when there’s an intersection between the work that they are doing and the political system. It’s one of the difficulties of democracy generally.

We have a system where we want our law enforcement investigators and our prosecutors to be free from politics, to be independent, to play it straight. But sometimes that involves investigations that touch on politics and particularly in this hyper-partisan environment that we’ve been in, everything is suspect, everything you do one way or the other.

One thing that I have done is to be pretty scrupulous about not wading into investigation decisions or prosecution decisions or decisions not to prosecute. I have tried to be really strict in my own behavior about preserving the independence of law enforcement, free from my own judgments and political assessments, in some cases. And I don’t know why it would stop now.

Mike Dorney (ph) of Bloomberg.

QUESTION: Thank you, Mr. President.

On Aleppo, your views of (ph) what happens there, the responsibility of the Russian government, the Iranian government, the Assad regime (inaudible), but do you, as president of the United States, leader of the free world, feel any personal moral responsibility now at the end of your presidency for the carnage we’re all watching in Aleppo, which I’m sure disturbs you (inaudible)?

Secondly, also on Aleppo, you’ve again made clear your practical disagreements with (inaudible) and President-elect Trump has throughout his campaign, and he said again last night, that he wants to create safe zones in Syria. Do you feel like in this transition, you need to help him toward implementing that or is that not something you need to be doing?

OBAMA: Mike, I always feel responsible. I felt responsible when kids were being shot by snipers. I felt responsible when millions of people had been displaced. I feel responsible for murder and slaughter that’s taken place in South Sudan that’s not being reported on, partly because there’s not as much social media being generated from there.

There are places around the world where horrible things are happening and because of my office, because I’m president of the United States, I feel responsible. I ask myself every single day, is there something I could do that would save lives and make a difference and spare some child who doesn’t deserve to suffer. So that’s a starting point. There’s not a moment during the course of this presidency where I haven’t felt some responsibility.

That’s true, by the way, for our own country. When I came into office and people were losing their jobs and losing their homes and losing their pensions, I felt responsible and I would go home at night and I would ask myself, was there something better that I could do or smarter that I could be that would make a difference in their lives, that would relieve their suffering and relieve their hardship.

So with respect to Syria, what I have consistently done is taken the best course that I can to try to end the civil war while having also to take into account the long-term national security interests of the United States. And throughout this process, based on hours of meetings — if you tallied it up, days and weeks of meetings — where we went through every option in painful detail with maps and we had our military and we had our aid agencies and we had our diplomatic teams, and sometimes, we’d bring in outsiders who were critics of ours.

OBAMA: Whenever we went through it, the challenge was that short of putting large numbers of U.S. troops on the ground uninvited, without any international law mandate, without sufficient support from Congress, at a time when we still had troops in Afghanistan and we still had troops in Iraq and we had just gone through over a decade of war and spent trillions of dollars and when the opposition on the ground was not cohesive enough to necessarily govern a country and you had a military superpower in Russia prepared to do whatever it took to keep its (inaudible) involved and you had a regional military power in Iran that saw their own vital strategic interests at stake and were willing to send in as many of their people or proxies to support the regime.

And in that circumstance, unless we were all in and willing to take over Syria, we were going to have problems. And everything else was tempting because we wanted to do something and it sounded like the right thing to do but it was going to be impossible to do this on the cheap. And in that circumstance, I have to make decision as president of the United States as to what is best — I’m sorry.

What’s going on? Somebody’s not feeling good. All right. Why don’t we have — we got — we can get our doctors back there to help out. Somebody want to go to my doctor’s office and just send them — all right. Where was I? So we couldn’t do it on the cheap. Now, it may be —

QUESTION: Can we get a doctor in here? Can that be arranged?

OBAMA: Can somebody help out, please, and get Doc Jackson in here? Somebody grabbing our doctor?

QUESTION: Thank you, Mr. President.

OBAMA: Of course. In the meantime, just give her a little room. Doctor will be here in a second. You guys know where the doctor’s office is? So just go through the palm doors. Its right — its right next to the map room. There he is. All right. There’s Doc Jackson. He’s all right. OK. The doctor — the doctor’s in the house.

So — And I don’t mean that — I mean that with all sincerity. I understand the impulse to want to do something, but ultimately what I’ve had to do is to think about, what can we sustain, what is realistic? And my first priority has to be, what’s the right thing to do for America? And it has been our view that the best thing to do has been to provide some support to the moderate opposition so that they could sustain themselves. And that you wouldn’t see anti-Assad regime sentiments just pouring into Al- Nusra and Al-Qaeda or ISIL that we engaged our international partners in order to put pressure on all the parties involved. And to try to resolve this through diplomatic and political means. I cannot claim that we’ve been successful. And so that’s something that, as is true with a lot of issues and problems around the world, I have to go to bed with every night.

But I continue to believe that it was the right approach given what realistically we could get done. Absent a decision, as I said, to go into much more significant way. And that, I think would not have been a sustainable or good for the American people because we had a whole host of other obligations that we also had to meet, wars we had already started and that were not yet finished.

With respect to the issue of safe zones , it is a continued problem, a continued challenge with safe zones is if you are setting up those zones on Syrian territory, then that requires some force that is willing to maintain that territory in the absence of consent from the Syrian government and now the Russians or the Iranians.

So it may be that with Aleppo’s tragic situation unfolding that in the short term, if we can get more of the tens of thousands who are still trapped there out , that so long as the world’s eyes are on them and they are feeling pressure, the regime in Russia concludes that they are willing to find some arrangement, perhaps in coordination with Turkey, whereby those people can be safe.

Even that will probably be temporary, but at least it solves a short-term issue that’s going to arise.

Unfortunately we are not there yet because right now we have Russians and Assad claiming that basically all the innocent civilians who were trapped in Aleppo are out when international organizations, humanitarian organizations who know better and who are on the ground, have said unequivocally that there are still tens of thousands who are trapped and prepared to leave under pretty much any conditions.

And so right now our biggest priority is to continue to put pressure wherever we can to try to get them out.

(CROSSTALK)

OBAMA: Mike, I can’t have too much…

QUESTION: (OFF-MIKE) but do you see, responsibility notwithstanding, moving in that direction or help President-elect Trump move in that direction?

OBAMA: I will help President Trump — President-elect Trump with any advice, counsel, information that we can provide so that he, once he’s sworn in, can make a decision.

Between now and then, these are decisions that I have to make based on the consultations that I have with our military and the people who have been working this every single day. Peter Alexander (ph).

QUESTION: Mr. President, thank you very much.

Can you, given all the intelligence that we have now heard, assure the public this was once and for all a free and fair election? And specifically on Russia, do you feel any obligation now as they have been insisting that this isn’t the case to show the proof, as it were? They say, put your money where your mouth is and declassify some of the intelligence and the evidence that exists.

And more broadly, as it relates to Donald Trump on this very topic, are you concerned about his relationship with Vladimir Putin, especially given some of the recent cabinet picks, including his selection for secretary of state, Rex Tillerson, who toasted Putin with champagne over oil deals together? Thank you.

OBAMA: I may be getting older because these multipart questions, I start losing track.

(LAUGHTER)

OBAMA: I can assure the public that there was not the kind of tampering with the voting process that was our concern and will continue to be of concern going forward, that the votes that were cast were counted, they were counted appropriately.

We have not seen evidence of machines being tampered with, so that assurance I can provide.

That doesn’t mean that we find every single, you know, potential probe of every single voting machine all across the country, but we paid a lot of attention to it. We worked with state officials, et cetera, and we feel confident that that didn’t occur and that the votes were cast and they were counted.

And so that’s on that point. What was the second one?

QUESTION: Say more about declassification.

OBAMA: Declassification. Look, we will provide evidence that we can safely provide, that does not compromise sources and methods. But I’ll be honest with you, when you are talking about cybersecurity, a lot of it is classified and we’re not going to provide it, because the way we catch folks is by knowing certain things about them that they may not want us to know and if we’re gonna monitor this stuff effectively going forward, we don’t want them to know that we know.

So, this is one of those situations where, unless the American people genuinely think that the professionals in the CIA, the FBI, our entire intelligence infrastructure, many of whom — by the way, served in previous administrations and who are Republicans — are less trustworthy than the Russians. Then people should pay attention to what our intelligence agencies say.

This is part of what I meant when I said we’ve got to think what is happening to happening to our political culture here. The Russians can’t change us or significantly weaken us. They are a smaller country, they are a weaker country, their economy doesn’t produce anything that anybody wants to buy except oil and gas and arms. They don’t innovate.

But they can impact us if we lose track of who we are. They can impact us if we abandon our values. Mr. Putin can weaken us just like he’s trying to weaken Europe if we start buying into notions that it’s OK to intimidate the press, or lock up dissidents, or discriminate against people because of their faith or what they look like.

And what I worry about — more than anything — is the degree to which because of the fierceness because of the partisan battle, you start to see certain folks in the Republican Party and Republican voters suddenly finding a government and individuals who stand contrary to everything that we stand for as being OK, because that’s how much we dislike Democrats.

I mean, think about it. Some of the people who historically have been very critical of me for engaging with the Russians and having conversations with them, also endorsed the president-elect, even as he was saying that we should stop sanctioning Russia and being tough on them and work together with them against our common enemies.

It was very complimentary of Mr. Putin personally. Now that — that wasn’t news. The president-elect during the campaign said so. And some folks who had made a career out of being anti-Russian, didn’t say anything about it. And then after the election, suddenly they’re asking, oh, why didn’t you tell us that maybe the Russians were trying to help our candidate? Well, come on.

There was a survey some of you saw where — not this just one poll, but pretty credible source, 37 percent of Republican voters approve of Putin. Over a third of Republican voters approve of Vladimir Putin, the former head of the KGB. Ronald Reagan would roll over in his grave. And how did that happen? It happened in part because for too long, everything that happens in this town, everything that’s said is seen through the lens of does this help or hurt us relative to Democrats or relative to President Obama. And unless that changes, we’re going to continue to be vulnerable to foreign influence because we’ve lost track of what it is that we’re about and what we stand for.

With respect to the president-elect’s appointments, it is his prerogative, as I have always said, for him to appoint who he thinks can best carry out his foreign policy or his domestic policy. It is up to the Senate to advise and consent. There will be plenty of time for members of the Senate to go through the record of all his appointees and determine whether or not they’re appropriate for the job.

Martha (inaudible).

QUESTION: Mr. President, I want to talk about Vladimir Putin again. Just to be clear, do you believe Vladimir Putin himself authorized the hack? And do you believe he authorized that to help Donald Trump?

And on the intelligence, one of the things Donald Trump cites is Saddam Hussein and the weapons of mass destruction and that they were never found. Can you say unequivocally that this was not China, that this was not a 400-pound guy sitting on his bed as Donald Trump says? And do these types of tweets and kinds of statements from Donald Trump embolden the Russians?

OBAMA: When the report comes out before I leave office, that will have drawn together all the threads, and so I don’t want to step on their work ahead of time. What I can tell you is that the intelligence that I’ve seen gives me great confidence in their assessment that the Russians carried out this hack.

QUESTION: Which hack?

OBAMA: The hack of the DNC and the hack of John Podesta.

Now, the — but again, I think this is exactly why I want the report out, so that everybody can review it. And this has been briefed and the evidence in closed session has been provided on a bipartisan basis, not just to me, it’s been provided to the leaders of the House and the Senate and the chairmen and ranking members of the relevant committees. And I think that what you’ve already seen is, at least some of the folks who’ve seen the evidence don’t dispute I think the basic assessment that the Russians carried this out.

QUESTION: But specifically, could (ph) you not say that…

OBAMA: Well, Martha, I think what I want to make sure of is that I give the intelligence community a chance to gather all the information.

But I’d make a larger point, which is, not much happens in Russia without Vladimir Putin. This is a pretty hierarchical operation. Last I checked, there’s not a lot of debate and democratic deliberation, particularly when it comes to policies directed at the United States. We have said and I will confirm that this happened at the highest levels of the Russian government and I will let you make that determination as to whether there are high-level Russian officials who go off rogue and decide to tamper with the U.S. election process without Vladimir Putin knowing about it.

QUESTION: So I wouldn’t be wrong in saying the president thinks Vladimir Putin authorized the hack?

OBAMA: Martha, I’ve given you what I’ve — what I’m gonna give you.

What was your second question?

QUESTION: Do the tweets and do the statements by — by Donald Trump embolden Russia?

OBAMA: As I said before, I think that the president-elect, you know, is still in transition mode from campaign to governance. I think he hasn’t gotten his whole team together yet. He still has campaign spokespersons sort of filling in and appearing on cable shows. And there is just a whole different attitude and vibe when you’re not in power as when you are in power.

So rather than me sort of characterize the appropriateness or inappropriateness of what he is doing at the moment, I think what we have to see is how will the president-elect operate and how will his team operate when they’ve been fully briefed on all these issues. They have their hands on all the levers of government. And they have got to start making decisions.

One way I do believe that the president-elect can approach this that would be unifying is to say that we welcome a bipartisan independent process that gives the American people an assurance not only that votes are counted properly, that the elections are fair and free, but that we have learned lessons about how internet propaganda from foreign countries can be released into the political bloodstream and that we have got strategies to deal with it for the future.

The more this can be non-partisan, the better served the American people are going to be, which is why I made the point earlier and I’m going to keep on repeating this point, our vulnerability to Russia or any other foreign power is directly related to how divided, partisan, dysfunctional our political process is. That’s the thing that makes us vulnerable.

If fake news that’s being released by some foreign government is almost identical to reports that are being issued through partisan news venues, then it’s not surprising that that foreign propaganda will have a greater effect. It doesn’t seem that far-fetched compared to some of the other stuff that folks are hearing from domestic propagandists.

To the extent that our political dialogue is such where everything is under suspicion, and everybody is corrupt, and everybody is doing things for partisan reasons, and all of our institutions are, you know, full of malevolent actors, if that’s the story line that is being put out there by whatever party is out of power, then when a foreign government introduces that same argument, with facts that are made up, voters who have been listening to that stuff for years, who have been getting that stuff every day from talk radio or other venues, they’re going to believe it.

So if we want to really reduce foreign influence on our elections, then we had better think about how to make sure that our political process, our political dialogue is stronger than it has been.

Mark Langley (ph).

QUESTION: Thank you, Mr. President.

I wonder whether I could move you from Russia to China for a moment.

OBAMA: Absolutely.

QUESTION: Your successor spoke by phone with the president of Taiwan the other day, and declared subsequently that he wasn’t sure why the United States needed to be bound by the One China Policy.

He suggested it could be used as a bargaining chip perhaps to get better terms on a trade deal or more cooperation on North Korea. There’s already evidence that tensions between the two sides have increased a bit, and just today, the Chinese have seized an underwater drone in the South China Sea.

Do you agree, as some do, that our China policy could use a fresh set of eyes and what’s the big deal about having a short phone call with the president of Taiwan? Or do you worry that these types of unorthodox approaches are setting us on a collision course with perhaps our biggest geopolitical adversary?

OBAMA: That’s a great question.

I’m somewhere in between. I think all of our foreign policy should be subject to fresh eyes. I think one of the — I’ve said this before, I am very proud of the work I’ve done. I think I’m a better president now than when I started. But you know, if you’re here for eight years in the bubble, you start seeing things a certain way and you benefit from — the democracy benefits, America benefits from some new perspectives.

And I think it should be not just the prerogative, but the obligation of a new president to examine everything that’s been done and see what makes sense and what doesn’t. That’s what I have done when I came in and I’m assuming any new president’s gonna undertake those same exercises.

And given the importance of the relationship between United States and China, given how much is at stake in terms of the world economy, national security, our presence in the Asia-Pacific, China’s increasing role in international affairs, there’s probably no bilateral relationship that carries more significance and where there’s also the potential if that relationship breaks down or goes into full conflict mode that everybody is worse off. So I think it’s fine for him to take a look at it. What I have advised the president-elect is that across the board on foreign policy, you want to make sure that you’re doing it in a systematic, deliberate, intentional way.

And since there’s only one president at a time, my advice to him has been that before he starts having a lot of interactions with foreign governments other than the usual courtesy calls, that he should want to have his full team in place, that he should want his team to be fully briefed on what’s gone on in the past and where the potential pitfalls may be, where the opportunities are, what we’ve learned from eight years of experience so that as he’s then maybe taking foreign policy in a new direction, he’s got all the information to make good decisions, and by the way, that all of government is moving at the same time and singing from the same hymnal.

And with respect to China — and let’s just take the example of Taiwan, there has been a longstanding agreement essentially between China and the United States, and to some agree the Taiwanese, which is to not change the status quo. Taiwan operates differently than mainland China does. China views Taiwan as part of China, but recognizes that it has to approach Taiwan as an entity that has its own ways of doing things.

OBAMA: The Taiwanese have agreed that as long as they’re able to continue to function with some agree of autonomy, that they won’t charge forward and declare independence. And that status quo, although not completely satisfactory to any of the parties involved, has kept the peace and allowed the Taiwanese to be a pretty successful economy and — of people who have a high agree of self-determination. What I understand for China, the issue of Taiwan is as important as anything on their docket.

The idea of One China is at the heart of their conception as a nation. And so if you are going to upend this understanding, you have to have thought through what the consequences because the Chinese will not treat that the way they’ll treat some other issues. They won’t even treat it the way they issues around the South China Sea, where we’ve had a lot of tensions. This goes to the core of how they see themselves.

And their reaction on this issue could end up being very significant. That doesn’t mean that you have to adhere to everything that’s been done in the past, but you have to think it through and have planned for potential reactions that they may engage in. All right. Isaac Dovere, Politico.

QUESTION: Thank you Mr. President. Two questions on where this all leaves us.

OBAMA: What leaves us? Where my presidency leaves us? It leaves us in a really good spot.

(LAUGHTER)

OBAMA: If we make some good decisions going forward.

QUESTION: What do you say to the electors who are going to meet on Monday and are thinking of changing their votes? Do you think they should be given an intelligence briefing about the Russian activity or should they bear in mind everything you have said and have said already (ph)? Should they — should votes be bound by the state votes as they’ve gone? And long-term, do you think that there is need for Electoral College reform that was tied to the popular vote?

OBAMA: Sounded like two but really was one.

(LAUGHTER)

OBAMA: I love how these start. I’ve got two questions, but each one has four parts.

(LAUGHTER)

QUESTION: On the Democratic Party, your labor secretary is running for — to be the chair of the Democratic National Committee. Is the vision that you’ve seen him putting forward what you think the party needs to be focused on? And what do you think about the complaint that say that the future democratic committee shouldn’t be a continuation of some of your political approach? Part of that is complaints that decisions that you have made as president and leader of the party has structurally weakened the DNC and the Democratic Party and they think that that has led to or has help lead to some of the losses in elections around the country. Do you regret any of those decisions?

OBAMA: I’ll take the second one first and say that Tom Perez has been, I believe one of the best secretaries of labor in our history. He is tireless. He is wicked smart. He has been able to work across the spectrum of you know, labor, business, activists. He has produced. I mean, if you look at his body of work on behalf of working people, what he’s pushed for in terms of making sure that workers get a fair deal, decent wages, better benefits, that their safety is protected on the job. He has been extraordinary.

Now others who have declared are also my friends and fine people as well. And the great thing is, I don’t have a vote in this. So – so – so we’ll let the process unfold, I don’t think it’s going to happen any time soon. I described to you earlier what I think needs to happen, which is that the democratic party, whether that’s entirely through the DNC or through rebuilding of state parties, or some other arrangement, has to work at the grassroots level, has to be present in all 50 states, has to have a presence in counties.

Has to think about in that extension (ph) how are we speaking directly to voters.

I will say this, and I’m not going to engage in too much punditry. But that I could not be prouder of the coalition that I put together in my — each of my campaigns. Because it was inclusive and it drew in people who normally weren’t interested in politics and didn’t participate.

But I’d like to think — I think I can show that in those elections, I always cast a broad net. I always said first and foremost we’re Americans, that we have a common creed, that there’s more that we share than divides us. And I want to talk to everybody and get a chance to get everybody’s vote.

I still believe what I said in 2004 which is this red state-blue thing is a construct. Now it is a construct that has gotten more and more powerful for a whole lot of reasons from gerrymandering, to big money, to a way that the media is splintered.

And so people are just watching what reinforces their existing biases as opposed to having to listen to different points of view. So there are all kinds of reasons for it. But outside the realm of electoral politics, I still see people the way I saw them when I made that speech, full of contradictions and some regional differences but basically, folks care about their families.

They care about having meaningful work. They care about making sure their kids have more opportunity than they did. They want to be safe. They want to feel like things are fair.

And whoever leads the DNC and any candidate with the Democratic brand going forward, I want them to feel as if they can reach out and find that common ground and speak to all of America. And that requires some organization.

And you’re right that — and I said this in my earlier remarks, that what I was able to do during my campaigns, I wasn’t able to do during midterms. It’s not that we didn’t put in time and effort into it. I spent time and effort into it. But the coalition I put together didn’t always turn out to be transferable.

And the challenge is that — you know, some of that just has to do with the fact that when you are in the party in power and people are going through hard times like they were in 2010, they are going to punish to some degree the president’s party regardless of what organizational work is done.

Some of it has to do with just some deep standing traditional challenges for Democrats like during off-year elections the electorate is older and we do better with the younger electorate. But we know those things are true.

And I didn’t crack the code on that. And if other people have ideas about how to do that even better, I’m all for it.

So with respect to the electors, I’m not going to wade into that issue. Because, again, it’s the American people’s job and now electors’ job to decide my successor. It is not my job to decide my successor.

And I have provided people with a lot of information about what happened during the course of the election, but more importantly, the candidates themselves I think talked about their beliefs and their vision for America.

The president-elect I think has been very explicit what he cares about and what he believes in. And so it’s not in my hands now, it’s up to them.

QUESTION: what about long term about the Electoral College?

OBAMA: Long term with respect to the Electoral College, the Electoral College is a vestige, it’s a carry-over from an earlier vision of how our federal government was going to work that put a lot of premium on states, and it used to be that the Senate was not elected directly, it was through state legislatures. And it’s the same type of thinking that gives Wyoming two senators and — with about half a million people and California with 33 million get the same two.

So there’s — there are some structures in our political system as envisioned by the founders that sometimes are going to disadvantage Democrats, but the truth of the matter is is that if we have a strong message, if we’re speaking to what the American people care about, typically, the popular vote and the electoral college vote will align.

And I guess — I guess part of my overall message here as I leave for the holidays is that if we look for one explanation or one silver bullet or one easy fix for our politics, then we’re probably going to be disappointed. There are just a lot of factors in what’s happened, not just over the last few months, but over the last decade that has made both politics and governance more challenging. And I think everybody’s raised legitimate questions and legitimate concerns.

I do hope that we all just take some time, take a breath, that’s certainly what I’m going to advise Democrats, to just reflect a little bit more about how can we — how can we get to a place where people are focused on working together based on at least some common set of facts? How can we have a conversation about policy that doesn’t demonize each another? How can we channel what I think is the basic decency and goodness of the American people so it reflects itself in our politics, as opposed to it being so polarized and so nasty that in some cases, you have voters and unelected officials who have more confidence and faith in a foreign adversary than they have in their neighbors?

And those go to some bigger issues. How is it that we have some voters or some elected officials who think that Michelle Obama’s healthy eating initiative and school nutrition program is a greater threat to democracy than, you know, our government going after the press if they’re issuing a story they don’t like? I mean, that’s — that’s an issue that I think, you know, we’ve got to — we’ve got to wrestle with. And we will.

People have asked me how you feel after the election and so forth and I say well, look, this is a clarifying moment. It’s a useful reminder that voting counts, politics counts. What the president- elect is going to be doing is gonna be very different than what I was doing and I think people will be able to compare and contrast and make judgments about what worked for the American people. And I hope that building off the progress we’ve made, that what the president-elect is proposing works.

What I can say with confidence is that what we’ve done works. That I can prove. I can show you where we were in 2008 and I can show you where we are now. And you can’t argue that we are not better off, we are.

And for that, I thank the American people and then more importantly I thank — well, not importantly, as importantly — I was going to say Josh Earnest…

(LAUGHTER)

OBAMA: … for doing such a great job. For that, I thank the American people, I thank the men and women in uniform who serve. I haven’t gotten to the point yet where I’ve been overly sentimental. I will tell you that when I was doing my last Christmas party photo — I know many of you have participated in these, they’re pretty long.

Right at the end of the line, the President’s Marine Corps Band comes in, those who have been performing. And I take a picture with them. And that was the last time that I was going to take a picture with my Marine Corps Band after an event. And I got a little choked up.

Now I was in front of marines so I had to like tamp it down. But it was just one small example of all of the people who have contributed to our success. I am responsible for where we’ve screwed up, the successes are widely shared with all of the amazing people who have been part of this administration.

OK? Thank you, everybody. Mele Kalikimaka!

 

Full Text Political Transcripts October 20, 2016: President Barack Obama’s Speech Defending the Affordable Care Act Obamacare

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & 114TH CONGRESS:

Remarks by the President on the Affordable Care Act

Source: WH, 10-20-16

Miami Dade College
Miami, Florida

1:51 P.M. EDT

THE PRESIDENT:  Hello, Miami!  (Applause.)  Thank you so much.  Well, everybody have a seat.  Have a seat.  It is good to see all of you!  It’s good to be back at Miami-Dade!  (Applause.) One of my favorite institutions!  (Applause.)  Love this school.

I want to thank your longtime president and great friend, Eduardo J. Padrón.  (Applause.)  And to all the faculty and staff, and of course, most importantly, the students, for hosting me — I want to say how grateful I am.  I want to thank the wonderful elected officials who are here today.  I’m going to just point out two outstanding members of Congress — Debbie Wasserman Schultz — (applause) — and Ted Deutch.  (Applause.)

So this is one of my last visits here as President.  Now, once I’m not President —

AUDIENCE MEMBER:  Nooo —

THE PRESIDENT:  No, no, the good news is, once I’m no longer President I can come more often.  (Applause.)  Right now, usually I can only come to Florida when I’m working.  But when I’m out of office, I can come here for fun.  (Laughter.)

But the first thing I want to say is thank you for your support, and thank you for the opportunity and the privilege you’ve given me to serve these past eight years.  I remember standing just a few blocks north of here in the closing days of the 2008 campaign.  And at that point, we were already realizing that we were in the midst of the worst economic crisis of our lifetimes.  We didn’t know where the bottom would be.  We were still in the middle of two wars.  Over 150,000 of our troops were overseas.  But thanks to the hard work and the determination of the American people, when I come here today the story is different.

Working together, we’ve cut the unemployment rate in Florida by more than half.  Across the country, we turned years of job losses into the longest streak of job creation on record.  We slashed our dependence on foreign oil, doubled our production of renewable energy.  Incomes are rising again — they rose more last year than any time ever recorded.  Poverty is falling — fell more last year than any time since 1968.  Our graduation rates from high school are at record highs.  College enrollment is significantly higher than it was when we came into office.  Marriage equality is a reality in all 50 states.  (Applause.)

So we’ve been busy.  This is why I’ve got gray hair.  (Laughter.)  But we did one other thing.  We fought to make sure that in America, health care is not just a privilege, but a right for every single American.  And that’s what I want to talk about today.  (Applause.)  That’s what I want to talk about here today.

You’ve heard a lot about Obamacare, as it’s come to be known.  You heard a lot about it in the six and a half years since I signed it into law.  And some of the things you heard might even be true.  But one thing I want to start with is just reminding people why it is that we fought for health reform in the first place.  Because it was one of the key motivators in my campaign.

And it wasn’t just because rising health costs were eating into workers’ paychecks and straining budgets for businesses and for governments.  It wasn’t just because, before the law was passed, insurance companies could just drop your coverage because you got sick, right at the time you needed insurance most.

It was because of you.  It was because of the stories that I was hearing all around the country, and right here in Florida — hearing from people who had been forced to fight a broken health care system at the same time as they were fighting to get well.

It was about children like Zoe Lihn, who needed heart surgery when she was just 15 hours old — just a baby, just a infant.  And she was halfway to hitting her lifetime insurance cap before she was old enough to walk.  Her parents had no idea how they could possibly make sure that she continued to make progress.  And today, because of the Affordable Care Act, Zoe is in first grade and she’s loving martial arts.  And she’s got a bright future ahead of her.  (Applause.)

We fought so hard for health reform because of women like Amanda Heidel, who lives here in South Florida.  As a girl, she was diagnosed with diabetes — and that’s a disease with costs that can add up quickly if you don’t have insurance, can eat away at your dreams.  But thanks to the Affordable Care Act, Amanda got to stay on her parents’ plan after college.  When she turned 26, Amanda went online, she shopped for an affordable health insurance plan that covered her medications.  Today, she’s pursuing a doctorate in psychology.  And Amanda said that the Affordable Care Act “has given me the security and freedom to choose how I live my life.”  The freedom and security to choose how I live my life.  That’s what this was all about.

Zoe and Amanda, the people who I get letters from every single day describing what it meant not to fear that if they got sick, or a member of their family got sick, if they, heaven forbid, were in an accident, that somehow they could lose everything.

So because of this law, because of Obamacare, another 20 million Americans now know the financial security of health insurance.  So do another 3 million children, thanks in large part to the Affordable Care Act and the improvements, the enhancements that we made to the Children’s Health Insurance Program.  And the net result is that never in American history has the uninsured rate been lower than it is today.  Never.  (Applause.)  And that’s true across the board.  It’s dropped among women.  It’s dropped among Latinos and African Americans, every other demographic group.  It’s worked.

Now, that doesn’t mean that it’s perfect.  No law is.  And it’s true that a lot of the noise around the health care debate, ever since we tried to pass this law, has been nothing more than politics.  But we’ve also always known — and I have always said — that for all the good that the Affordable Care Act is doing right now — for as big a step forward as it was — it’s still just a first step.  It’s like building a starter home — or buying a starter home.  It’s a lot better than not having a home, but you hope that over time you make some improvements.

And in fact, since we first signed the law, we’ve already taken a number of steps to improve it.  And we can do even more  — but only if we put aside all the politics rhetoric, all the partisanship, and just be honest about what’s working, what needs fixing and how we fix it.

So that’s what I want to do today.  This isn’t kind of a rah-rah speech.  I might get into the details.  I hope you don’t mind.  (Laughter.)

So let’s start with a basic fact.  The majority of Americans do not — let me repeat — do not get health care through the Affordable Care Act.  Eighty percent or so of Americans get health care on the job, through their employer, or they get health care through Medicaid, or they get health care through Medicare.  And so for most Americans, the Affordable Care Act, Obama, has not affected your coverage — except to make it stronger.

Because of the law, you now have free preventive care.  Insurance companies have to offer that in whatever policy they sell.  Because of the law, you now have free checkups for women. Because of the law, you get free mammograms.  (Applause.)  Because of the law, it is harder for insurance companies to discriminate against you because you’re a woman when you get health insurance.  (Applause.)  Because of the law, doctors are finding better ways to perform heart surgeries and delivering healthier babies, and treating chronic disease, and reducing the number of people that, once they’re in the hospital, end up having to return to the hospital.

So you’re getting better quality even though you don’t know that Obamacare is doing it.

AUDIENCE MEMBER:  Thanks, Obama.

THE PRESIDENT:  Thanks, Obama.  (Laughter and applause.)

Because of the law, your annual out-of-pocket spending is capped.  Seniors get discounts on their prescription drugs because of the law.  Young people can stay on their parents’ plan — just like Amanda did — because of the law.  (Applause.)  And Amanda was able to stay on her parents’ plan and then get insurance after she aged out, even though she has what used to be called a preexisting condition — because we made it illegal to discriminate against people with preexisting conditions.  (Applause.)

By the way, before this law, before Obamacare, health insurance rates for everybody — whether you got your insurance on the job, or you were buying it on your own — health insurance rates generally were going up really fast.  This law has actually slowed down the pace of health care inflation.  So, every year premiums have gone up, but they’ve gone up the slowest in 50 years since Obamacare was passed.  In fact, if your family gets insurance through your job, your family is paying, on average, about $3,600 less per year than you would be if the cost trends that had existed before the law were passed had continued.  Think about that.  That’s money in your pocket.

Now, some people may say, well, I’ve seen my copays go up, or my networks have changed.  But these are decisions that are made by your employers.  It’s not because of Obamacare.  They’re not determined by the Affordable Care Act.

So if the Affordable Care Act, if Obamacare hasn’t changed the coverage of the 80 percent of Americans who already had insurance, except to make it a better value, except to make it more reliable, how has the law impacted the other 15 or 20 percent of Americans who didn’t have health insurance through their job, or didn’t qualify for Medicaid, or didn’t qualify for Medicare?

Well, before the Affordable Care Act, frankly, you were probably out of luck.  Either you had to buy health insurance on your own, because you weren’t getting it through the job, and it was wildly expensive, and your premiums were going up all the time, and if you happened to get sick and use the insurance, the insurer the next year could drop you.  And if you had had an illness like cancer or diabetes, or some other chronic disease, you couldn’t buy new insurance because the insurance company’s attitude was, you know what, this is just going to cost us money, we don’t want to insure you.

So if you were trying to buy health insurance on your own, it was either hugely expensive or didn’t provide very effective coverage.  You might buy a policy thinking that it was going to cover you.  It was sort of like when I was young and I bought my first car, I had to buy car insurance.  And I won’t name the insurance company, but I bought the insurance because it was the law, and I got the cheapest one I could get, because I didn’t have any money — and it was a really beat-up car.  (Laughter.)  And I remember somebody rear-ends me, and I call up the insurance company, thinking maybe I can get some help, and they laughed at me.  They’re all like, what, are you kidding?  (Laughter.)  It didn’t provide any coverage other than essentially allowing me to drive.  (Laughter.)

Well, that’s what it was like for a lot of people who didn’t have health insurance on the job.  So that meant that a lot of people just didn’t bother getting health insurance at all.  And when they got sick, they’d have to go to the emergency room.

AUDIENCE MEMBER:  (Inaudible.)

THE PRESIDENT:  Well, that’s true, too.

And so you’re relying on the emergency room, but the emergency room is the most expensive place to get care.  And because you weren’t insured, the hospital would have to give you the care for free, and they would have to then make up for those costs by charging everybody else more money.  So it wasn’t good for anybody.

So what the Affordable Care Act is designed to do is to help those people who were previously either uninsured or underinsured.  And it worked to help those people in two ways.

First, we gave states funding to expand Medicaid to cover more people.  In D.C. and the 31 states that took us up on that, more than 4 million people have coverage who didn’t have it before.  They now have health insurance.

Second, for people who made too much to qualify for Medicaid even after we expanded it, we set up what we call marketplaces on HealthCare.gov, so you could shop for a plan that fits your needs, and then we would give you tax credits to help you buy it.  And most people today can find a plan for less than $75 a month at the HealthCare.gov marketplace when you include the tax credits that government is giving you.  That means it’s less than your cellphone bill — because I know you guys are tweeting a lot — (laughter) — and texting and selfies.  (Laughter.)  And the good news is, is that most people who end up buying their coverage through the marketplaces, using these tax credits, are satisfied with their plans.

So not only did Obamacare do a lot of good for the 80-plus percent of Americans who already had health care, but now it gave a new affordable option to a lot of folks who never had options before.  All told, about another 10 percent of the country now have coverage.

The Affordable Care Act has done what it was designed to do: It gave us affordable health care.

So what’s the problem?  Why is there still such a fuss?  Well, part of the problem is the fact that a Democratic President named Barack Obama passed the law.  (Applause.)  And that’s just the truth.  (Laughter.)  I mean, I worked really, really hard to engage Republicans; took Republican ideas that originally they had praised; said, let’s work together to get this done.  And when they just refused to do anything, we said, all right, we’re going to have to do it with Democrats.  And that’s what we did.

And early on, Republicans just decided to oppose it.  And then they tried to scare people with all kinds of predictions — that it would be a job-killer; that it would force everyone into government-run insurance; that it would lead to rationing; that it would lead to death panels; that it would bankrupt the federal government.  You remember all this.  And despite the fact that all the bad things they predicted have not actually happened — despite the fact that we’ve created more jobs since the bill passed in consecutive months than any time on record — (applause) — despite the fact that the uninsured rate has gone down to its lowest levels ever, despite that fact that it’s actually cost less than anybody anticipated and has shown to be much less disruptive on existing plans that people get through their employers, despite the fact that it saved Medicare over $150 billion — which makes that program more secure — despite all this, it’s been hard, if not impossible, for any Republican to admit it.

They just can’t admit that a lot of good things have happened and the bad things they predicted didn’t happen.  So they just keep on repeating, we’re going to repeal it.  We’re going to repeal it, and we’re going to replace it with something better — even though, six and a half years later, they haven’t  — they still haven’t shown us what it is that they would do that would be better.

But — and this is actually the main reason I’m here — just because a lot of the Republican criticism has proven to be false and politically motivated doesn’t mean that there aren’t some legitimate concerns about how the law is working now.  And the main issue has to do with the folks who still aren’t getting enough help.  Remember, I said 80 percent of people, even before the law passed, already had health insurance.  And then we expanded Medicaid, and we set up the marketplaces, and another 10 percent of people got health insurance.  Well, but that still leaves that last 10 percent.  And the fact that that last 10 percent still has difficulties is something that we’ve got to do something about.

Now, part of the reason for this is, as I already mentioned to you, not every state expanded Medicaid to its citizens, which means that some of the most vulnerable working families that the law was designed to help still haven’t gotten insurance.  As you may have heard, Florida is one of those states.  If your governor could put politics aside —

AUDIENCE:  Booo —

THE PRESIDENT:  Don’t boo — vote.  (Applause.)

If your governor would just put politics aside and do what’s right, then more than 700,000 Floridians would suddenly have access to coverage.  And, by the way, that would hold down costs for the rest of you, because there would be less uncompensated care in hospitals.  And it means that people who did sign up for the marketplace, who oftentimes may be sicker, qualify for Medicaid and so they’re not raising costs in the marketplace.

In fact, if the 19 states who so far have not expanded Medicaid would just do so, another 4 million people would have coverage right now all across the country.

So that’s step number one.  And that’s, by the way, just completely in the control of these governors.  They could be doing it — right now.  They could do it tomorrow.

Now, the second issue has to do with the marketplaces.  Although the marketplaces are working well in most of the states, there are some states where there’s still not enough competition between insurers.  So if you only have one insurer, they may decide we’re going to jack up rates because we can, because nobody else is offering a better price.

In those states where the governor or legislature is hostile to the ACA, it makes it harder to enroll people because the state is not actively participating in outreach.  And so, as a consequence, in those states enrollment in the plan — especially enrollment of young people — has lagged.

And what that means is that the insurance pool is smaller and it gets a higher percentage of older and sicker people who are signing up — because if you’re sick or you’re old, you’re more likely to say, well, I’m going to sign up, no matter what, because I know I’m going to need it; if you’re young and healthy like you guys, you say, eh, I’m fine, life is good — so you have more older and sicker people signing up, fewer younger and healthier people signing up, and that drives rates up, because the people who use health care most end up being in the insurance pool; people who use it least are not.

And then, in some cases, insurers just set their prices too low at the outset because they didn’t know what the insurance pool was going to look like, and then they started losing money.  And so now they’ve decided to significantly increase premiums in some states.

Now, it’s these premium increases in some of the states in the marketplace that sometimes attracts negative headlines.  Remember, these premium increases won’t impact most of the people who are buying insurance through the marketplace, because even when premiums go up, the tax credits go up to offset the increases.  So people who qualify for tax credits, they may not even notice their premiums went up because the tax credit is covered.

And keep in mind that these premium increases that some of you may have read about have no effect at all if you’re getting health insurance on the job, or through Medicaid or Medicare.  So for the 80 [percent]-plus people who already had health insurance, if your premium is going up, it’s not because of Obamacare.  It’s because of your employer or your insurer — even though sometimes they try to blame Obamacare for why the rates go up.  It’s not because of any policy of the Affordable Care Act that the rates are going up.

But if you are one of the people who doesn’t get health care on the job, doesn’t qualify for Medicaid, doesn’t qualify for Medicare — doesn’t qualify for a tax credit to help you buy insurance,  because maybe you made just a little bit too much money under the law — these premium increases do make insurance less affordable.  And in some states, the premium increases are manageable.  Some are 2 percent or 8 percent, some 20 percent.  But we know there are some states that may see premiums go up by 50 percent or more.

And an extreme example is Arizona, where we expect benchmark premiums will more than double.  Part of this is because Arizona is one of those states that had really low average premiums — among the lowest in the country — so now insurance companies basically are trying to catch up, and they also don’t have a lot of competition there.  And meanwhile, in states like Florida, the failure to expand Medicaid contributes to higher marketplace premiums.  And then there are some other states that just because of the nature of their health care systems, or the fact that they’re rural and people are dispersed, so it’s harder to provide health care, more expensive — they have a tougher time controlling costs generally.

Again, the tax credits in the ACA will protect most consumers from the brunt of these premium increases.  And with the ability to shop around on HealthCare.gov — which works really well now — most people can find plans for prices even lower than this year’s prices.  But there are going to be people who are hurt by premium increases or a lack of competition and choice.  And I don’t want to see anybody left out without health insurance.  I don’t want to see any family having to choose between health insurance now or saving for retirement, or saving for their kids’ college education, or just paying their own bills.

So the question we should be asking is, what do we do about these growing pains in the Affordable Care Act, and how do we get the last 9 percent of Americans covered?  How do we reach those last 9 percent?  And how do we make sure that premiums are more stable going forward, and the marketplace insurance pools are more stable going forward?

Well, I can tell you what will not work.  Repealing the Affordable Care Act will not work.  (Applause.)  That’s a bad idea.  That will not solve the problem.  Because right off the bat, repeal would take away health care from 20 million people.  We’d go back where 80 percent of people had health insurance instead of 90 percent — right off the bat.  And all the reforms that everybody benefits from that I talked about — like young Americans being able to stay on their parents’ plans, or the rules that prevent insurance companies from discriminating against people because of a preexisting condition like diabetes or cancer, or the rule now that you can’t charge somebody more just because they’re a woman — all those reforms would go away for everybody, because that’s part of Obamacare.

All the progress that we’ve made in controlling costs and improving how health care is delivered, progress that’s helped hold growth in the price of health care to the slowest rate in 50 years — all that goes away.  That’s what repeal means.  It would be bad for everybody.  And the majority of Americans, even if they don’t know that they’re benefitting from Obamacare, don’t want to see these benefits and protections taken away from their families now that they have them.  I guarantee you there are people who right now think they hate Obamacare.  And if somebody told them, all right, we’re repealing it, but now your kid who is on your plan is no longer on your plan, or now you’ve got a preexisting condition and you can’t buy health insurance — they’d be shocked.  They’d be — what do you mean?

So repeal is not the answer.  Here is what we can do instead to actually make the Affordable Care Act work even better than it’s working right now.  And I’ve already mentioned one.

Florida and every state should expand Medicaid.  (Applause.)  Cover more people.  It’s easy to do, and it could be done right now.  You’d cover 4 million more Americans, help drive down premiums for folks who buy insurance through the marketplace.  And, by the way, because the federal government pays for almost all of this expansion, you can’t use as an excuse that, well, the state can’t afford it — because the federal government is paying it.  States like Louisiana that just expanded Medicaid — you had a Republican governor replaced by a Democratic governor.  He said, I want that money.  Expanded Medicaid, and found not only does it insure more people, but it’s actually saved the state big money and makes people less dependent on expensive emergency room care.  So that’s step number one.

Step number two.  Since overall health care costs have turned out to be significantly lower than everyone expected since we passed Obamacare, since that’s saved the federal government billions of dollars, we should use some of that money, some of those savings to now provide more tax credits for more middle-income families, for more young adults to help them buy insurance.  It will make their premiums more affordable.  And that’s not just good for them — it’s good for everybody.  Because when more people are in the marketplace, everybody will benefit from lower premiums.  Healthier people, younger people start joining the pool; premiums generally go down.  That would be number two.

The third thing we should do is add what’s called a public plan fallback — (applause) — to give folks more options in those places where there are just not enough insurers to compete.  And that’s especially important in some rural communities and rural states and counties.  If you live in L.A. right now, then it’s working fine.  There are a lot of insurers because it’s a big market, there are a lot of providers.  But if you’re in some remote areas, or you’re near some small towns, it may be that the economics of it just don’t work unless the government is providing an option to make it affordable.  And, by the way, this is not complicated.  Basically, you would just wait and see — if the private insurers are competing for business, then you don’t have to trigger a public option.  But if no private insurers are providing affordable insurance in an area, then the government would step in with a quality plan that people can afford.

And, by the way, this is not a radical idea.  This idea is modeled on something that Republicans championed under George Bush for the Medicare Part D drug benefit program.  It was fine when it was their idea.  The fact that they’re now opposed to it as some socialist scheme is not being consistent, it’s being partisan.

And finally, we should continue to encourage innovation by the states.  What the Affordable Care Act says is, here’s how we propose you insure your populations, but you, the state, can figure out a different way to accomplish the same goal — providing affordable, comprehensive coverage for the same number of residents at the same cost — then go right ahead.  There may be more than one way to skin a cat.  Maybe you’ve got an idea we haven’t thought of.  Just show us, don’t talk about it.  Show us what the plan looks like.

Republicans who claim to care about your health insurance choices and your premiums, but then offer nothing and block common-sense solutions like the ones that I propose to improve them — that’s not right.  And my message to them has been and will continue to be:  Work with us.  Make the system better.  Help the people you serve.  We’re open to good ideas, but they’ve got to be real ideas — not just slogans, not just votes to repeal.  And they’ve got to pass basic muster.  You can’t say, well, if we just do — if we just plant some magic beans — (laughter) — then everybody will have health insurance.  No, we’ve got to have health care economists and experts look at it and see if the thing would actually work.

So that’s where we are.  Number one, Obamacare is helping millions of people right now.  The uninsured rate has never been lower.  It’s helping everybody who already has health insurance, because it makes their policies better.  Number two, there are still too many hardworking people who are not being reached by the law.  Number three, if we tweak the program to reach those people who are not currently benefitting from the law, it will be good for them and it will be good for the country.  Number four, if we repeal this law wholesale that will hurt the people who don’t have coverage right now.  It will hurt the 20 million who are already getting help through the law.  And it will hurt the country as a whole.

So this should be an easy choice.  All it does — all it requires is putting aside ideology, and in good faith trying to implement the law of the land.  And what we’ve learned, by the way, is that when governors and state legislators expand Medicaid for their citizens and they hold insurance companies accountable, and they’re honest with uninsured people about their options, and they’re working with us on outreach, then the marketplace works the way it’s supposed to.  And when they don’t, the marketplaces tend to have more problems.  And that shouldn’t be surprising.  If state leaders purposely try to make something not work, then it’s not going to run as smoothly as if they were trying to make it work.  Common sense.  You don’t even have to go to Miami Dade to figure that out.  (Laughter.)

The point is, now is not the time to move backwards on health care reform.  Now is the time to move forward.  The problems that may have arisen from the Affordable Care Act is not because government is too involved in the process.  The problem is, is that we have not reached everybody and pulled them in.  And think about it.  When one of these companies comes out with a new smartphone and it had a few bugs, what do they do?  They fix it.  They upgrade — unless it catches fire, and they just — (laughter) — then they pull it off the market.  But you don’t go back to using a rotary phone.  (Laughter.)  You don’t say, well, we’re repealing smartphones — we’re just going to do the dial-up thing.  (Laughter.)  That’s not what you do.

Well, the same basic principle applies here.  We’re not going to go back to discriminating against Americans with preexisting conditions.  We’re not going to go back to a time when people’s coverage was dropped when they got sick.  We’re not going to go back to a situation where we’re reinstating lifetime limits in the fine print so that you think you have insurance, and then you get really sick or you kid gets really sick, and you hit the limit that the insurance company set, and next thing you know they’re not covering you anymore, and you got to figure out how you come up with another $100,000 or $200,000 to make sure that your child lives.  We’re not going to go back to that.

I hear Republicans in Congress object, and they’ll say, no, no, no, no, we’ll keep those parts of Obamacare that are popular; we’ll just repeal everything else.  Well, it turns out that the sum of those parts that are popular in Obamacare is Obamacare.  (Applause.)  It’s just people don’t always know it.  And repealing it would make the majority of Americans worse off when it comes to health care.

And as I said, part of this is just — you know, health care is complicated.  Think about this speech — it’s been pretty long, and you’re just — you’re thinking, wow, I just want to take a picture with the President or something.  (Laughter.)  So it’s hard to get people focused on the facts.  And even reporters who have covered this stuff — and they do a good job; they’re trying to follow all the debate.  But a lot of times they just report, “Premium increases.”  And everybody thinks, wow, my insurance rates are going up, it must be Obama’s fault — even though you don’t get health insurance through Obamacare, you get it through your job, and even though your increases have gone up a lot slower.  Or suddenly you’re paying a bigger copay, and, ah, thanks Obama.  (Laughter.)  Well, no, I had nothing to do with that.

So part of it is this is complicated, the way it gets reported.  There’s a lot of hysteria around anything that happens.  And what we need to do is just focus on this very specific problem — how do we make sure that more people are getting coverage, and folks right now who are not getting tax credits, aren’t getting Medicaid, how do we help them, how do we reach them.  And we can do it.

Instead of repealing the law, I believe the next President and the next Congress should take what we’ve learned over the past six years and in a serious way analyze it, figure out what it is that needs to get done, and make the Affordable Care Act better and cover even more people.  But understand, no President can do it alone.  We will need Republicans in Congress and in state governments to act responsibly and put politics aside.  Because I want to remind you, a lot of the Affordable Care Act is built on Republican ideas.

In fact, Bernie Sanders is still mad at me because we didn’t get single-payer passed.  Now, we couldn’t get single-payer passed, and I wanted to make sure that we helped as many people as possible, given the political constraints.  And so we adopted a system that Republicans should like; it’s based on a competitive, market-based system in which people have to a responsibility for themselves by buy insurance.

And maybe now that I’m leaving office, maybe Republicans can stop with the 60-something repeal votes they’ve taken, and stop pretending that they have a serious alternative, and stop pretending that all the terrible things they said would happen have actually happened, when they have not, and just work with the next President to smooth out the kinks.

Because it turns out, no major social innovation in America has ever worked perfectly at the start.  Social Security didn’t. Its benefits were stingy at first.  It left out a whole lot of Americans.  The same was true for Medicare.  The same was true for Medicaid.  The same was true for the prescription drug law.  But what happened was, every year, people of goodwill from both parties tried to make it better.  And that’s what we need to do right now.

And I promise, if Republicans have good ideas to provide more coverage for folks like Amanda, I will be all for it.  I don’t care whose idea it is, I just want it to work.  They can even change the name of the law to ReaganCare.  (Laughter.) Or they can call it Paul Ryan Care.  I don’t care — (laughter) — about credit, I just want it to work because I care about the American people and making sure they’ve got health insurance.

But that brings me to my final point, and that is change does not typically come from the top down, it always comes from the bottom up.  The Affordable Care Act was passed because the American people mobilized, not just to get me elected, but to keep the pressure on me to actually do something about health care and to put pressure on members of Congress to do something about it.  And that’s how change happens in America.  It doesn’t happen on its own.  It doesn’t happen from on high.  It happens from the bottom up.  And breaking gridlock will come only when the American people demand it.

So that’s why I’m here.  Only you can break this stalemate, but educating the public on the benefits of the Affordable Care Act, and then pressing your elected officials to do the right this and supporting elected officials who are doing the right things.

And this is one of the reasons why I’m so proud of what Miami-Dade College is doing, because it’s making sure that students and faculty, and people throughout this community know about the law, know about how to sign up for health care, and then actually helps people sign up.  And I’m incredibly proud of the leadership Joe Peña and the entire team in encouraging people to sign up.

Thanks to them, Miami-Dade has been hosting enrollment office hours and workshops, even on nights and weekends.  Right here on the Wolfson campus, and on all the Miami-Dade campuses, you can go for a free one-on-one session where a trained expert can walk you through the process and answer any questions you have — and then help you sign up for health care right there and then.  Joe says he doesn’t have a conversation without making sure people know how to get covered.  The more young and healthy people like you who do the smart thing and sign up, then the better it’s going to work for everybody.

And the good news is, in a few days, you can do just that because Open enrollment, the time when you can start signing up, begins on November 1.  And you just need to go to HealthCare.gov, which works really well now.  (Laughter.)

And campuses will be competing to come up with the most creative ways to reach people and get them signed up — and I’m pretty sure that Miami-Dade can set the standard for the rest of the country.  ‘Cause that’s how you do.  (Applause.)  That’s how you do.

So much has changed since I campaigned here in Miami eight Octobers ago.  But one thing has not: this is more than just about health care.  It’s about the character of our country.  It’s about whether we look out for one another.  It’s about whether the wealthiest nation on earth is going to make sure that nobody suffers.  Nobody loses everything they have saved, everything they have worked for because they’re sick.  You stood up for the idea that no American should have to go without the health care they need.

And it’s still true today.  And we’ve proven together that people who love this country can change it — 20 million people out there will testify.  I get letters every day, just saying thank you because it’s made a difference in their lives.  And what true then is true now.  We still need you.  Our work to expand opportunity to all and make our union more perfect is never finished — but the more we work, and organize, and advocate, and fight, the closer we get.

So I hope you are going to be busy this November signing folks up.  But more importantly, I hope, for all the young people here, you never stop working for a better America.  And even though I won’t be President, I’ll keep working right alongside you.

Thank you, everybody.  God bless you.  God bless America.  Thank you.  (Applause.)

END
2:40 P.M. EDT

Full Text Political Transcripts January 8, 2016: President Barack Obama vetoes GOP Congress’ ObamaCare repeal the Reconciliation Act

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 114TH CONGRESS:

Veto Message from the President — H.R. 3762

Source: WH, 1-8-16

TO THE HOUSE OF REPRESENTATIVES:

I am returning herewith without my approval H.R. 3762, which provides for reconciliation pursuant to section 2002 of the concurrent resolution on the budget for fiscal year 2016, herein referred to as the Reconciliation Act.  This legislation would not only repeal parts of the Affordable Care Act, but would reverse the significant progress we have made in improving health care in America.  The Affordable Care Act includes a set of fairer rules and stronger consumer protections that have made health care coverage more affordable, more attainable, and more patient centered.  And it is working.  About 17.6 million Americans have gained health care coverage as the law’s coverage provisions have taken effect.  The Nation’s uninsured rate now stands at its lowest level ever, and demand for Marketplace coverage during December 2015 was at an all-time high.  Health care costs are lower than expected when the law was passed, and health care quality is higher — with improvements in patient safety saving an estimated 87,000 lives.  Health care has changed for the better, setting this country on a smarter, stronger course.

The Reconciliation Act would reverse that course.  The Congressional Budget Office estimates that the legislation would increase the number of uninsured Americans by 22 million after 2017.  The Council of Economic Advisers estimates that this reduction in health care coverage could mean, each year, more than 900,000 fewer people getting all their needed care, more than 1.2 million additional people having trouble paying other bills due to higher medical costs, and potentially more than 10,000 additional deaths.  This legislation would cost millions of hard-working middle-class families the security of affordable health coverage they deserve.  Reliable health care coverage  would no longer be a right for everyone:  it would return to being a privilege for a few.

The legislation’s implications extend far beyond those who would become uninsured.  For example, about 150 million Americans with employer-based insurance would be at risk of higher premiums and lower wages.  And it would cause the cost of health coverage for people buying it on their own to skyrocket.

The Reconciliation Act would also effectively defund Planned Parenthood.  Planned Parenthood uses both Federal and non-federal funds to provide a range of important preventive care and health services, including health screenings, vaccinations, and check-ups to millions of men and women who visit their health centers annually.  Longstanding Federal policy already prohibits the use of Federal funds for abortions, except in cases of rape or incest or when the life of the woman would be endangered.  By eliminating Federal Medicaid funding for a major provider of health care, H.R. 3762 would limit access to health care for men, women, and families across the Nation, and would disproportionately impact low-income individuals.

Republicans in the Congress have attempted to repeal or undermine the Affordable Care Act over 50 times.  Rather than refighting old political battles by once again voting to repeal basic protections that provide security for the middle class, Members of Congress should be working together to grow the economy, strengthen middle-class families, and create new jobs.  Because of the harm this bill would cause to the health and financial security of millions of Americans, it has earned my veto.

Full Text Obama Presidency July 1, 2015: President Barack Obama’s Twitter Chat on Obamacare

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 114TH CONGRESS:

  1. Gotta go, but this was fun. Let’s keep the health care conversation going – share how the for you or your family.

 

 

 

  • President Obama retweeted Victor Samuda

    people lack info/turned off by political noise. w court case done, let’s focus on getting people signed up.

    President Obama added,

 

 

  • President Obama retweeted ryan kartune

    pushing to make 2 yrs comm college free; permit refinancing on student loans; push colleges to keep tuition low

    President Obama added,

 

 

  • President Obama retweeted JustinGreen∞

    respect the nyt, but not buying peas in guac. onions, garlic, hot peppers. classic.

    President Obama added,

 

 

  • President Obama retweeted natalie

    was listening to outkast/liberation and the black keys/lonely boy this morning.

    President Obama added,

 

 

  • President Obama retweeted Christina Loucks

    there’s a hardship exemption; fine only applies to folks who can afford insurance but choose not to.

    President Obama added,

 

 

  • President Obama retweeted Emma’s Politics

    have principles and issues you are passionate about, and act; worry more about doing something than being something.

    President Obama added,

 

 

  • President Obama retweeted Sable Systems

    EX-IM bank helps US companies export; that means good paying american jobs. optimistic that congress gets it done.

    President Obama added,

 

 

  • President Obama retweeted Kat Robison

    now’s time to encourage states that held off for political reasons to do the right thing; contact state officials!

    President Obama added,

 

 

  • President Obama retweeted nathan210

    congratulations! hope you guys are getting sleep. nothing beats babies!

    President Obama added,

 

 

  • President Obama retweeted Raul Gonzales

    not true – like last year, insurers request premium hikes, but must be approved; expect final increases to be less

    President Obama added,

 

 

  • President Obama retweeted Dylan Green

    we need to encourage states to take advantage of medicaid expansion; could insure 4 mil more people in 22 states!

    President Obama added,

 

 

 

 

 

Full Text Obama Presidency July 1, 2015: President Barack Obama’s Remarks in a Discussion on Obamacare the Affordable Care Act Nashville, TN

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 114TH CONGRESS:

Remarks by the President in a Discussion on the Affordable Care Act — Nashville, TN

Source: WH, 7-3-15

Taylor Stratton Elementary School
Nashville, Tennessee

1:36 P.M. CDT

THE PRESIDENT:  Hello, everybody!  (Applause.)  Everybody, have a seat.  Have a seat.  Well, it’s good to be back in Nashville.  (Applause.)  I like Nashville.  I don’t know if you noticed, I come back here quite a bit.  (Laughter.)

First of all, can everybody please give Kelly a big round of applause?  (Applause.)  In addition to being wonderful and somewhat feisty spirit, as I have learned, she also has the distinction of possibly being the first person ever to be picked up at her house by a presidential motorcade.  (Laughter.)  Which I thought was pretty cool.  Well, it turned out it was so close to the school, so we said, well, we might as well just swing by and get her.  (Laughter.)

I want to thank the school for hosting us here today, because I know it’s a lot of work when we come into town.  Very much appreciate everybody who was involved in that.  You have a great Mayor, Karl Dean, who’s here, so please give Karl a big round of applause.  (Applause.)  There he is with his beautiful family right there.  Family, stand up.  Family, come on.  There’s his family — yay!  (Applause.)  You can’t imagine what a family has to put up with when you’re in public service.  So we really appreciate all of them.

Kelly already mentioned him, but he is somebody who is what you want out of a member of Congress.  He works hard.  He calls it like he sees them.  He’s willing to do courageous stuff even when it’s not popular.  He is a gentleman, one of my favorite people — Jim Cooper.  (Applause.)

Also here is somebody who knows health care well, was a health care professional, a doctor and executive, and knows a little bit about politics because he used to be the former Majority Leader.  When I first came in, in fact, he and I had a chance to work together on a number of things, and he’s been a terrific advocate on behalf of health care for a lot of people — Mr. Bill Frist.  (Applause.)

So, with that, I think I’m going to take off my jacket, get a little more relaxed here.  Part of the reason we came to Tennessee — in addition to me just liking Nashville and liking the state, generally, is that Tennessee has a history of innovation when it comes to health care, doing some very creative stuff — health care professionals, doctors, nurses, hospitals and executives working alongside nonprofits and the public sector to make sure that people are getting the very best health care they can, and also being able to control costs in a sensible way.
And thanks to the Affordable Care Act and the efforts of people like Jim who took some very tough votes, we now have about 166,000 Tennesseans who have health care who didn’t have it before.  Folks like Kelly.  (Applause.)

In addition to the people who are able to buy health insurance through the exchanges, through the marketplaces that were set up through the Affordable Care Act, I think it’s important to remember that everybody who has health insurance benefitted and continues to benefit from this law — even though a lot of folks don’t know it.

So if you have health insurance through the job, you’re able to keep your child on health insurance up until they’re 26 years old because of this law.  (Applause.)  And that’s provided millions of young people across the country with health insurance who may not have had it before.  And that’s especially important as young people are transitioning, getting their first job — they may not always get a job that has full benefits, and this way they’re able to make sure that they stay healthy.

In addition, if you’re a senior citizen, or somebody who’s disabled, it turns out that you are getting discounts on your prescription drugs that you may not have noticed but are saving you potentially hundreds or even thousands of dollars.  And there are millions of people across the country who are benefitting.  That is because of this law.

If you don’t fall under those categories and you’re just somebody who’s got health insurance on the job, you now are protected, so that if you, let’s say, lost that job, or decided to move to a job or just start your own business, you can’t be prohibited from getting health insurance because of a preexisting condition.  That’s a protection that everybody is benefitting from as a consequence of this law.  (Applause.)

If you’re a woman, you can’t be charged just for being a woman as a consequence of this law.  (Applause.)  Last I checked, that’s about over half of the population, so that’s a pretty large constituency.  You’re able to get free preventive care, including mammograms, as a consequence of this law, on your insurance.

So there are a whole host of things that fall under the Affordable Care Act that are benefitting 100 million, 150 million people.  They just may not be aware of it.  But what it’s done is it’s made health care stronger, more secure, and more reliable in America.  You don’t always notice that until you need it — the way Kelly needed it.  And that peace of mind, that understanding that if you get sick you’re not going to lose your job — or you’re not going to lose your house, you’re not going to lose all your savings, that you’re going to be able to get quality care — that is extraordinarily important.

I’ve said before, the scariest day of my life was when Sasha was three months old — my daughter — and she got meningitis.  And the only reason we knew was because we had a great primary care physician and we were able to rush to an emergency room and the doctors and nurses did extraordinary work.  And I was feeling helpless in that situation, but I thought, what would happen if I was in the same situation and I didn’t have health care, and I didn’t have a primary care physician to call in the middle of the night because we noticed she wasn’t crying the same way she usually cried?  Because of the law we passed, there are parents who just aren’t going to have to face that.  And that’s priceless.

Now, the good news is that, contrary to some of the expectations, not only has the law worked better than we expected, not only are 16 million people now getting health insurance that didn’t have it before, not only do we now have the lowest uninsured rate since we started tracking people and how much health insurance they had, but it’s actually ended up costing less than people expected.  And health care costs have been held — the inflation on health care costs have actually proved to be the lowest — since the Affordable Care Act passed  — in the last 50 years.  So we’re actually seeing less health care inflation.

And part of the reason is because the law also encouraged health care providers and doctors, nurses, hospitals to start thinking more creatively about how can we get a better bang for our health care dollar.  How can we make sure that rather than spending a lot of money on unnecessary tests or readmissions, we’re encouraging really high-quality care that’s good for the patient but also good for health care spending.

And this is another area where Tennessee actually has been really innovative.  In fact, it won a $65 million grant for state innovation, where you’ve got hospitals and doctors and nurses and not-for-profits and other groups working together to figure out how can we, for example, identify potential diabetes patients early, make sure that they’re getting healthy quicker, preventing some of the worst elements of it.  And even though it might involve a little extra spending on the front end, it turns out it saves hundreds of thousands of dollars on the back end; improves quality of life, improves quality of care, cuts costs, which is good for our economy, good for patients, and good for America.

So I’m feeling pretty good about how health care is going.  (Applause.)  And the thing I’ve never lost sight of, though, is that this is about people.  This is not about politics, it’s not about Washington.  It’s about families and loved ones, and the struggle and the fear that comes about when you have a serious illness and knowing that you’ve got not just your own family, but also a community that has your back.

And you heard Kelly talk about her story.  Sitting right next to Kelly is a wonderful woman named Natoma Canfield, who came down with me today.  She’s from Ohio, and she wrote a letter to me, pretty similar to Kelly’s, back in — five years ago, so back in 2010, when we were still in the middle of this fight to try to get health care that’s affordable for everybody.  And Natoma had been diagnosed with cancer, had beat it back, then was buying health insurance on the individual market and it turned out that the costs were just skyrocketing so high that she just couldn’t afford it anymore.

And she wrote to me a passionate letter about why we needed to get this done.  And I would always refer back to her letter whenever things got a little bleak and Congress wasn’t behaving as sensibly as Jim Cooper behaves.  (Laughter.)  And when we finally signed that bill, I had Natoma’s letter framed with the pen that I signed the bill with — one of the pen’s that I signed the bill with — just to remind me that this wasn’t about politics, this was about people.

And so I’m so glad Natoma is here, but I’m also glad that all of you are here.  And part of what I’m hoping is that with the Supreme Court case now behind us, what we can do is — (applause) — I’m hoping that what we can do is now focus on how we can make it even better.  Because it’s not as if we’ve solved all the problems in our health care system.  America still spends more on health care than any other advanced nation and our outcomes aren’t particularly better.

And so we know there’s still a lot of waste in the system.  We know that the quality of care isn’t always where it needs to be.  And so my hope is, is that on a bipartisan basis, in places like Tennessee, but all across the country, we can now focus on what have we learned.  What’s working?  What’s not working?  Are there further improvements we can make to improve quality?  Are there more ways we can encourage people to get preventive care so that they don’t get sick in the first place, so that we have a actual health care system instead of a disease care system?  Are there ways that we can do better to provide the support we need for outstanding primary care physicians and nurses, who oftentimes are coming out of school loaded up with debt and aren’t always getting the support that they need and aren’t always able to practice the way they want to practice?

There are huge areas of improvement and, frankly, there’s still a lot of people who aren’t insured.  Part of the design of the Affordable Care Act was that some people were going to buy health care on the marketplace; in some cases, we were going to allow states to expand their coverage through individualized programs in their states.  I think because of politics, not all states have taken advantage of the options that are out there.  Our hope is, is that more of them do.

We still have to sign a bunch of people up.  We’ve covered now about a third of the people who weren’t covered before this law passed, but that means there’s still two-thirds out there who still need some help and they’re still going to the emergency room at the last minute when something goes wrong.

And so we want to educate people.  We want to listen to folks.  We want to hear good ideas from all sources.  We want to think about this in a practical, American way instead of a partisan, political way.  And if we do that, then I think there’s still great strides to be made.

So I want to thank all of you for being here.  And with that, I’m just going to open it up for a bunch of questions.  And you can ask me about anything, but probably you should ask me a couple of questions about health care.  (Laughter.)  I’m also willing to talk about the women’s soccer team and how we’re going to beat whoever it is we’re playing up in Canada.  (Applause.)  I can talk about the NBA free agency.  (Laughter.)  I can talk about the Predators and hockey. (Applause.)  And I can talk about other things other than sports.  (Laughter.)

But the way we’re going to do this is we’re just going to — this is very casual.  I’m just going to call on folks.  The only rules I’m going to lay down are when you raise your hand, if you can wait — are there microphones in the audience?  So wait for a microphone so we can all hear you.  And I’d like you to introduce yourself.  And I’m going to try to make sure that we go boy, girl, boy, girl, so that it’s even.  (Laughter.)  Okay?  All right.

We’re going to start with this young lady right here in front.  You’ve got a microphone right here.  So remember to introduce yourself.  Go ahead and hand her the mic.  Sometimes we tell our folks to hang onto the mic because people keep it for too long.  (Laughter.)  But this looks like a pretty well-behaved group, so go ahead and hand them the mic.

Q    I am a Tennessee volunteer enrolling people in the Affordable Care Act.

THE PRESIDENT:  Thank you.

Q    Thank you.  (Applause.)  We live in a city with a lot of health care companies and a lot of great medical facilities who can take advantage of some of the things you mentioned.  What do you think ordinary people — people who are volunteers, or ordinary citizens can do to help make our health care system and our health insurance system better?

THE PRESIDENT:  Well, first of all, I want to thank you for volunteering, because so much of our challenge these first couple of years as we’ve gotten this started was just getting people information, because there was so much misinformation out there.
So, for example, a lot of people don’t know that through the exchange, through the Affordable Care Act exchange plan, there is enormous choice of plans.  And Tennessee actually has benefitted from some of the widest range of choices of just about any state. I think there are 70 options to choose from for people throughout the state.  And about 80 percent of people who are purchasing health insurance through these exchanges because they’re getting federal subsidies, they’re spending less than 100 bucks a month for good, quality care.  And that’s true nationwide.

So part of our goal here is just to give people good information.  And in fairness to folks, look, before I started tackling this whole health care thing, when I got a job I didn’t really pay attention to health care benefits.  You go to the job, and somebody from HR hands you a form and says, here, fill this out, and they tell you, well, you need to choose from two or three plans, and you kind of ask them, all right, well, what do you think?  (Laughter.)  They tell you, well, that one is pretty good, and you sign up for it.  Most of us don’t spend a lot of time thinking about health insurance until we get sick, unfortunately.

So getting people information, I think that’s something that is really helpful when it comes from neighbors, friends, coworkers, your church — because you have more trust.  Sometimes people don’t always trust what they see on television, especially on something that became sort of a political football.

I think the other thing is for citizens to share their stories of how it’s helped them not only with their friends, neighbors, coworkers, but also with their state legislators and with their governor, and writing letters and letting them know that this is helping people, it makes a difference — so that they then recognize that this is an important need and it’s worthy of support.

And then you’ve also got to take care of yourself.  But you look really good, so you’re obviously — (laughter) — getting exercise and eating right, and getting regular checkups and all that good stuff.  Because that’s helpful, as well.  That’s part of how we keep costs down, is making sure people are well-informed about what it takes to live a healthy life.

Great question, though.

All right, it’s a gentleman’s turn.  This guy right down here.  You’ve got a good-looking beard.  All right, hold on a second.  Let’s get the mic — like I said, you can just pass it down to him.

Q    It is an honor and a privilege to be here, Mr. President.  I live in Pikeville, Tennessee.  It’s about 50 miles north of Chattanooga.  And I’m here representing the 280,000 people that is uninsurable in the state of Tennessee with the Insure Tennessee Act.  And what we need is — we got no insurance.  We can’t get no insurance.  We don’t make enough to pay for insurance, but still yet we make too much to get a subsidy insurance.  And I would like to know if you are aware of this, or is there anything that — movements or acts that you can make on the part of our problem here?

THE PRESIDENT:  Well, first of all, I appreciate your comments.  There is something that can be done, but it’s going to be at the state level.  And I think that it’s important for state legislators to get together and find a uniquely Tennessee solution to the problem.

But understand, the way the law was set up was that states would have the option of expanding existing programs like Medicaid, and then you’d also have people who were buying health insurance on the marketplace and getting subsidies.  And the point you’re making is that if the state hasn’t taken action on one part of the program, then even with the good work that’s being done for people who are getting subsidies and purchasing insurance, you’re still leaving a bunch of folks out.  And here in Tennessee, that’s probably a couple hundred thousand people who could benefit if we really focused on how to fix it.

Now, as I said before, Tennessee has a history of bipartisan, smart, state-specific efforts to expand health insurance.  And I don’t expect that what’s good for Tennessee is automatically going to be the same as what’s good for California or what’s good for my home state of Illinois.  But given the strong history of innovation in health care in Tennessee and given the high quality of doctors and hospitals and nurses and networks that are here, you all should be able to find a solution.  And the federal government is there to help and to work with those states that are ready to get going.

I will tell you the states that have taken full advantage of all the federal options available, they have an even lower uninsured rate, and a healthier population, and more people signing up for the options that are available than those states that have not taken full advantage of those options.  And that’s just a fact.  And it is unfortunate that getting this done got so political.  Washington is kind of a crazy place.  But that doesn’t mean every place has got to be crazy.  (Laughter and applause.)  So I’d like to see some good sense spring forth from the great state of Tennessee, see if we can get this thing done. (Applause.)

All right.  Yes, right there.  Go ahead.

Q    Thank you so much for being here today and sharing with us.  I’m from St. Thomas Health and one of the administrators.  So the work that’s already been done, the exchange, we know we have work to do with expansion.  What would you envision are the next steps that we need to take in health care in general for our country?

THE PRESIDENT:  The areas where I think we can still make the biggest difference, in addition to making sure everybody is signed up for the options that they have, is to really think more about the delivery system of health care.  And this can get real complicated because we got a complicated health care system.  But I can boil it down maybe into layman’s terms.

Right now we spend too much money on the wrong things and not enough money on the right things.  So health care generally is very expensive in this country.  But if you look at how that money is spent, we don’t give enough incentives to health care providers to really focus just on the patient and the quality of care.  First of all, there’s way too much bureaucracy.  There’s way too much paperwork.  That wears out the patient.  It wears out the doctor.  It wears out the nurses.  They don’t like it.

The second problem is that because of the way that we’ve designed the payment system in health care, historically what happened was that, let’s say, a hospital or a doctor had a patient come in, says, I’ve got diabetes or I have I think maybe diabetes.  The hospital or the doctor would get paid to amputate the leg of a patient, but they wouldn’t get reimbursed if they just hired somebody to monitor whether that individual was taking their medicines on a regular basis and monitoring their eating habits, right?  So what ends up happening is, is that you don’t end up helping the patient who might have kept their leg if they were keeping up a regular regiment of looking after themselves.

The doctors don’t feel good about that.  The nurses don’t feel good about it.  But they just don’t have time because of the economics of the health care system.  So one of the things that we’re trying to do across the board — and Tennessee is actually doing some good innovation on this — is let’s reimburse people for the outcomes and the quality of care that people are getting.

So instead of — when that patient comes in, instead of worrying about just, okay, I’m going to bill for this test and I’m going to bill for this surgery, let’s tell them, if that person ends up having a good outcome, then you’re going to get reimbursed.  And the better the outcome, maybe the bigger the reimbursement.

And now it may turn out that it’s a good deal for the doctor to spend an extra half an hour with the patient very carefully going over the medicine they should be getting.  Or the hospital may say, you know what, we’re going to sign you up for a health club and make sure that you’re getting some regular exercise, or we’re going to reimburse you for a smoking-cessation program — and suddenly all that produces a better result.

But we’ve got to make sure that we’ve got a payment system that follows that logic of patient-centered care.  And as I said before, we’re already seeing that happening.  Part of the reason that we’ve actually seen health care costs slow — the inflation of health care slow is because folks are starting to get reimbursed in different ways, and health care groups are starting to organize themselves to focus on the quality of care as opposed to the amount of care.

If we can do that, see, what that does is it — first of all, it frees up resources.  It’s not good for anybody when health care costs go up because not only does the federal government have to pay more, the state of Tennessee has to pay more.  That means there’s less money left over for doctors, nurses, for health education.  It means higher premiums for the patients.  But it also means that if we’re saying — if we just cut 2 percent or 3 percent on the cost of health care, that’s hundreds of billions of dollars that we can now spend on something else.  We can spend that on education.  We can spend that on job training programs.  We can spend that on fixing some potholes.  And it can improve everybody’s quality of life.

So that I think is the area that we’re going to be spending a lot of focus and a lot time, in addition to making sure that people are able to sign up for the care that they need.  Because I want to emphasize, there are still too many people out there who haven’t signed up or can’t sign up for the health care that’s available to them.  And if we can clear away some of the politics, that will help, as well.

Good.  Gentleman, right here.

Q    Good afternoon, Mr. President.  My name is Eric Brown from Nashville, Tennessee.  I work for the Children’s Defense Fund and a small, local congregation here.  My question is more for veterans when it comes to health care.  I have a family member who’s a veteran.  She would like to have a female doctor. She’s been rejected about two or three times.  So I just wanted to hear more of your thoughts on that — how to help her to get the health care that she needs, but also have the safety that she needs for it as well.

THE PRESIDENT:  Okay.  Well, as most of you know, the VA system is an entirely separate health care system from the private sector health care systems that most of us use.

Here’s the basic principle:  If somebody is wearing our — the uniform of the armed services of this country and sacrificing and putting themselves in harm’s way to protect us, we’ve got to give them good health care when they come home.  (Applause.)  We’ve got to make sure that they get the very best.

Now, the good news is that the overwhelming majority of veterans are very satisfied with the health care they receive once they get into the system.  The bad news is that because a lot of the processing and systems in the VA system are outdated, sometimes it’s taking a long time for folks to get into the system, to get an appointment, to make sure that they’ve got a doctor that they’re comfortable with.  There are areas where there are still shortages — for example, in mental health, with a lot of folks coming back with PTSD — there haven’t been, historically, enough mental health services provided for our veterans.

So my Secretary of Veterans Affairs, Bob McDonald, who is a former — who’s a veteran himself, but also a former CEO of Procter & Gamble, so knows about big companies and big operations — he’s really been doing a good job in revamping how the VA system is organized generally.  It’s going to take some time.  It’s still not where it needs to be.

With respect to your — was it your sister, in particular?

Q    Mother-in-law.

THE PRESIDENT:  Your mother-in-law, in particular — we’ll get your name and your mother-in-law’s name, and we’ll find out what exactly the issue is.  But generally speaking, we’ve actually made an investment in women’s health care in the VA system, reflecting the fact that we now have extraordinary women who are serving in the armed services, and the health care needs of women are not always going to be the same as the health care needs of men.  And so we’ve actually been trying to boost the kinds of specialties and training that are needed to provide health care to women — our women veterans, and we’ve been expanding that.

And that’s something I’m very proud of.  We’ve made a significant inroad in that area.  Tell her thanks for her service.

All right, it’s a young lady’s turn.  Go ahead.  I’ll go here, and — don’t worry, I think I’ll be able to catch everybody.  Go ahead.  But she does have an Obama pin on, so I thought I’d — (laughter) — I figured I had to give her a little props for that.

Q    Thank you.  And thank you, Mr. President, for coming to Tennessee.  And my name is Brenda Gilmore.  I’m a member of the Tennessee General Assembly in the House.  And there are a number of members that are here, so I just wanted you to know that we support you.  We believe that health care is the right thing for everybody, and especially for Tennesseans.

And I wanted to ask you, with your background also being a state senator —

THE PRESIDENT:  State legislator.

Q    — do you have some strategies that you could share with us — (laughter) — that we could encourage our Governor to stay on the journey and to continue to find solutions to present Insure Tennessee, and to bring some of our colleagues over on the other side so that we can take the politics out of it and help them to understand how important this is to the quality of life for Tennesseans?  (Applause.)

THE PRESIDENT:  Well, I don’t presume to know as much as you do about Tennessee politics, so I will leave the expert advice to folks like Jim Cooper maybe.

But here’s the one thing I do know, is that elected officials respond to public opinion.  I think one of the challenges that we’ve had throughout this fight has been that there’s been a lot of misinformation out there.  And so if you stopped the average Tennessean on the street and you asked them, do you support making sure that insurance companies can’t bar you from getting health insurance because of a preexisting condition, eight out of 10 of them would say, absolutely, I support that.  Overwhelming majority of Republicans would support it just as much as Democrats did.

Now, if you asked them, did you know the Affordable Care Act is what is guaranteeing you don’t get blocked from getting health insurance with a preexisting condition, you’d get an argument with at least half those folks — “no, that’s not what it’s doing.”  So part of it is just providing people good information. That’s really important.  And if ordinary folks feel it’s important, then usually elected officials start responding.

I think the other thing to emphasize, which I know you’re already doing, is recognizing that not every state is the same, and that the truth is, is that there are a lot of different ways that states are approaching this problem.  And if everybody will just acknowledge that people should get health insurance, that they should be able to get affordable care when they need it — if that much is acknowledged, that base principle, then you can say to them, okay, here’s our ideas for how to do it, what are your ideas?  And people can come up with good ideas of their own.

I will say this.  People tend to forget that the Affordable Care Act model, with health care exchanges and buying on the — in the marketplace, and getting subsidies from the federal government — that was originally a model that was embraced by Republicans before I embraced it.  It’s the model that Mitt Romney signed into law in Massachusetts.  It’s the model that conservative organizations like Heritage Foundation thought were a good idea.

So my hope is that maybe now we can return to a constructive conversation about — if folks have better ideas, you should accept them.  My general rule is I have no pride of authorship here.  I just want to make sure Kelly has got health insurance and I want to make sure that Thelma has got health insurance, and I want to make sure this gentleman gets health insurance.  And if there’s a better way of doing it, let me know.

But it turns out that it’s hard.  (Laughter.)  So it’s got to be an idea that actually works.  It can’t be an idea that sounds good, but then doesn’t work.  That’s the only danger.  So if somebody tells you that, well, we’re going to prohibit insurance companies from barring you from getting health insurance if you’ve got a preexisting condition — which is popular — but we’re going to allow people not to get health insurance if they don’t feel like it, then the truth is that doesn’t work.  And the reason it doesn’t work is, if you think about it, if you knew that the insurance company couldn’t prevent you from getting health insurance once you were sick, you wouldn’t pay all those premiums until you got sick.  And then you’d go to your health insurance company and say, there’s a law you got to sell me health insurance — and you’d save a whole lot of money, but, of course, the whole insurance system would collapse.  It wouldn’t work.

So there are just some basic things that — basic realities about the health care system that have to be taken into account. But I think you should be open to other ideas.  Like I said, look, I didn’t mind stealing ideas from Mitt Romney.  (Laughter.) But the bottom line is:  What works?  What works?  And if Republican legislators have better ideas, they should present them.  But they have to be realistic.  They have to be meaningful.  (Applause.)

Okay.  The gentleman right here in the glasses.  Right here.  Yes.

Q    Thank you, Mr. President.  I work with Family and Children Service.  I am versed in the health care system and I help people enroll in the marketplace.  And I want to thank you so much on behalf of the many people I’ve been helping, especially the most vulnerable immigrant people, to get affordable health insurance.  We really thank you very much.

Also, I just want to ask you if you have any plans to expand the Affordable Care Act for sick migrant people, especially the people who don’t have enough documents in this country but they still live and work here for a long time.  Thank you.

THE PRESIDENT:  Well, we were very clear that the Affordable Care Act did not apply to people who are not here legally.  And that’s the law.  So that’s another example of — there’s a lot of misinformation about this.  The law says that if you are undocumented, if you’re not here legally, you can’t benefit from subsidies and the program that we’ve set up.

The real answer to your question is why don’t we have immigration reform so that people who’ve been here a long time who are otherwise law-abiding citizens, who oftentimes have children who are U.S. citizens, who are contributing to the society and are willing to pay their dues, pay taxes, get a background check — why don’t we give them a pathway so they can be legal.  (Applause.)  If we do that — if we reform the immigration system, which is all broken, then this problem that you just mentioned takes care of itself.

I mean, look, we should not be encouraging illegal immigration.  What we should be doing is setting up a smart, legal immigration system that doesn’t separate families, but does focus on making sure that people who are dangerous, people who are gang-bangers or criminals — that we’re deporting them as quickly as possible, that we’re focusing our resources there; that we’re focusing on a strong border.  We’ve made improvements on all those fronts, but we could be doing even more if we had immigration reform.

And we almost got that done.  We had a bipartisan bill come through the Senate that was very smart and was well-crafted.  It wasn’t exactly what I wanted, but it was a good compromise among a lot of different ideas.  The House of Representatives declined to call it to a vote, even though I think we had a majority of members of the House of Representatives who would be willing to vote for it.

I’ve taken some administrative actions to try to improve the system.  For example, us not deporting some young person who grew up here and been here since they were three or four or five years old, brought here by their parents, hasn’t done anything wrong, are going to school with our kids, or friends with our kids, and suddenly — in some cases, they didn’t even know that they weren’t citizens — and then they’re 18 years old and suddenly they can’t get a college scholarship because it turns out they don’t have the legal documents.

And I said, administratively, that’s not who we are to just send those kids back.  In some cases, they’ve never been to the country that their parents are from, don’t speak the language.  What do you mean we’re going to send them back?  Some of them serving in our military.

So we’ve done a lot administratively.  Ultimately, though, to really find a full solution to the problem we’re going to have to get congressional action.  And I suspect this will be a topic of conversation during the upcoming presidential campaign.

I should note by the way that Michelle is very happy that I cannot run.  (Laughter.)  That is good for the health care of our family.  (Laughter.)

Yes, go ahead.

Q    Thank you, Mr. President.  Marian Hurst from Mount Juliet, Tennessee.  And thanks to the ACA, I was able to retire and still get health insurance.  My question is, what are your thoughts on how to now manage the premiums?  I don’t know if you’re aware that BlueCross BlueShield of Tennessee has announced a significant increase after the one that they gave from 2014 to 2015.

THE PRESIDENT:  Well, keep in mind that the Affordable Care Act was designed so that there’s competition.  And folks in Tennessee benefitted over these last two years not only of a lot of healthy competition — more insurers came in offering plans than just about any other place — it was really impressive — but Tennessee’s premiums were also substantially lower than a lot of other states, and have been over the last couple of years.  The insurance companies now have come in requesting higher premiums.

The good news for people of Tennessee is this has to be reviewed and approved by the insurance commission.  And if — last year is a good example.  Last year there were a number of states where the insurance companies came in requesting significant spikes in premiums.  And there were a lot stories in the newspaper, just like there are this year, about, oh, premiums are skyrocketing and this is going to be terrible and all that.  When all the dust settled and the commissioners who were empowered to review these rates forced insurance companies to justify what they were seeking, what you discovered was, is that the rates actually didn’t go up as much as people thought.

So I think the key for Tennessee is just making sure that the insurance commissioner does their job in not just passively reviewing the rates, but really asking, okay, what is it that you are looking for here?  Why would you need very high premiums?  And my expectation is, is that they’ll come in significantly lower than what’s being requested.

But I think that this emphasizes the need for us to not let our foot off the gas when it comes to the delivery system reforms that I talked about earlier.  Because part of what’s happening in terms of health care costs is that as technology changes, and there are more cures for more diseases, people utilize them more. And if we aren’t smart about how we spend our health care dollars, if we want everything right away even if it’s not shown to be particularly effective, then that shoots up health care costs and ultimately premiums are going to keep on going up.

So we’ve got to think more carefully about this.  The best example of this, by the way, is prescription drugs.  The biggest spike in health care costs is around prescription drugs.  Now, some of this is just because drugs have gotten better and people are able to now deal with cholesterol or deal with other chronic problems through a drug regimen.  And that’s a good thing.  We should be happy about that.  But when you’ve got a situation where the brand-name drug costs 100 bucks a pill and the generic drug costs 10 bucks a pill, and the generic has been shown to be just as effective as the brand name, it’s good for all of us as consumers to make sure that we’re generally using the generic drug when we can.

And a lot of times — sometimes we’re very insistent because we’ve seen some fancy ad on TV — people are running around looking happy.  (Laughter.)  Until they read that thing about:  “This may cause serious side effects.”  (Laughter.)  Diarrhea, migraines.  (Laughter.)  I always laugh at those ads.  (Laughter.)

But a lot of times, because of the advertising, you’ll have somebody come into their doctor and say, well, I want X because I saw a TV ad, and if the doctor says, well, actually Y works just as well and is a lot cheaper — a lot of times, people’s attitude is no, no, no, I want X.  And if the system is set up where you’re getting X, then that means your premiums are going to go up.  If you want your premiums to stay low, then you have got to base your decisions on your doctor — you want your doctors and your nurses basing decisions on science and what’s proven as opposed to what’s being advertised.

And that’s just one example of how we’ve got to make sure that we continue to save money in the system.  Because if costs keep on going up and everybody wants everything and is not smart about how we’re spending out health care dollars, then, yes, premiums are going to end up going up too high.  But stay on your insurance commissioner, pay attention to what they’re doing.

Okay.  I got time for one more — but I’m going to take two.  (Laughter.)  Yes, sir, this gentlemen right here.

Q    I’m Walter Davis, and I’m a director of the Tennessee Health Care Campaign, which does both enrollment and advocating for Governor Haslam’s Insure Tennessee.  It’s wonderful to hear the success stories here.  But here in the South, we need help from the government and from supportive institutions to talk about the people being left behind.  And I want to make sure you meet Davy Crockett before you leave today.

THE PRESIDENT:  Is this Davy right here?

Q    Right there.

THE PRESIDENT:  Okay.

Q    Over there with the Tennessee Justice Center.  There are important stories about the people who are left out because of decisions by legislators.  And we love the legislators that are with us, both parties, but the other legislators need to meet people in the gap.

THE PRESIDENT:  Okay.  Well, you know what, I think this is like a handoff to Davy here.  (Laughter.)  So we’ll get you the mic here, Davy.  Hold on one second.  Is your name really Davy Crockett?

Q    Yes.

THE PRESIDENT:  That’s a cool name.  (Laughter.)  But you don’t have that beaver cap.  (Laughter.)

Q    I’ve got one at the house.

THE PRESIDENT:  You do?  (Laughter.)

Q    Yeah.

THE PRESIDENT:  Okay.  All right.

Q    My name is James Davy Crockett.  And I live in Bulls Gap, Tennessee.  And I want to know — I’ve been turned down four times for Social Security.  Is there anything that you can do to maybe push it through or something?  (Laughter.)  I mean, I have been turned down and I’d like to be able to get some help.

THE PRESIDENT:  All right.  Well, here, I’ll tell you what. Here’s the thing, Davy, I don’t run the Social Security Administration.  It’s the law.  But here’s one thing that does happen.  If I ask a question, I tend to get an answer pretty quick.  So what we’re going to do is we’re going to get your information, Davy, and I’ll make sure the Social Security Administrator takes a look at it and expedites it.  All right?  (Applause.)

Q    Thank you.

THE PRESIDENT:  Okay, thank you.

Davy Crockett!  (Applause.)  You all remember that TV show? Actually, a lot of people are too young here.  (Starts to sing)  Davy, Davy Crockett.  (Laughter.)  I loved that.

Right here.  This young lady is going to get the last question, because she wrote me a letter, and when people tell their stories that reminds me of why I’m doing what I’m doing.

Q    Thank you Mr. President.   My name is Margaret Mackatee (ph) and I’m a retired teacher and school administrator for 38 years in the great state of Ohio.  And I moved to Tennessee to be with my son and my grandchildren.  And my grandson, Patrick, said to say hi to you.

THE PRESIDENT:  Tell Patrick I said hey.  (Laughter.)

Q    Yes, sir.  The letter I wrote was after watching you make a speech to college students.  And at the time, it was after the fact of the death of my son.  And being off of health care  immediately after he graduated from Wright State University, and through the process of his illness and his death, how it affected me economically, and paying COBRA and shots.

And in the context of being a school administrator, as hard as that might have been to me, it was worse for my kids at school, going through much the same thing or worse, with no support system like I had, especially as we went through the economic downturn in the country.  And being a high school principal and watching my kids be homeless and transient and mobile, and much harder to grab ahold of.  And they would be into crime or stealing or whatever for survival on the streets.  And they would show up at school, or they’d get off the bus and come down and say, “Doctor Mackatee (ph), I need to go to the clinic because I’m sick.”

And so our little school clinics became their health care. And sometimes even their parents would come and say, hey, can your nurse check us out.  And at one time, we had one nurse for seven schools.

And so, in terms of people that are lost in the shuffle — especially at the secondary level — transient, homeless children — we had a huge population of homeless children and they kept my head on straight through the grief I felt in our family because they’re so compelling.  They don’t let — teenagers don’t let you sit around and whine.  They pull you forward into life.

And my concern for the school systems in this country is for the massive health care issues that walk in the doors of school systems who don’t have nursing care, who don’t have clinics that are staffed, who don’t have the resources.  And many of the teachers in America take care of the kids out of their pocket.  School cooks feed children — slip them a little bit.  I know for a fact that many of my kids only ate with confidence at school.  That’s one of the reasons I love Mrs. Obama and her notion of — (applause) — of decent school lunch.

I can remember walking into a school system and the lunch they served was a little piece of cheese, a little short pasty breadstick and a tiny little tomato sauce cup.  And that was lunch until Mrs. Obama brought focus to what was being served to our children.

So the kids in the country who are homeless and deprived and transient — as soon as a kid gets 15 or 16, it’s hard to — they come and they show up once in a while, or they go off and they bounce from home to home, or buddy to buddy, or situation to situation.  They’re the ones that I’m worried about falling through the cracks.

And I’m worried about our school system and the focus that we spend more time and effort trying to get what we used to call in Ohio “butts in seats to take tests,” instead of seeing to their health care needs and their mental health care needs and support needs, so that we can wholly educate a child in the United States of America.  (Applause.)

THE PRESIDENT:  That’s a great comment.  Well, first of all, Margaret, we’re so grateful for you sharing your personal story, because it reminds us of the goodness and generosity of the American people, when somebody like Margaret is going through her own pain but she’s thinking about people other than herself and her family.  That kind of spirit is to be found all across the country.  It’s not unique to one party.  It’s not unique to one region.  There are good people like Margaret everywhere.

A couple of points I’d just pick up on that you’ve mentioned.  Number one — when we talk about the health care system, we have to just remind ourselves of the economic impact of the health care system on families.  It’s not just feeling bad.  Obviously, when you’re sick, your most important concern is getting well.  But what is also true is, is that when you get sick and you don’t have health insurance, then that is draining your resources for other things.

Bankruptcy because of medical expenses is a huge portion of the bankruptcies in America.  When families lose their house, or a parent has to stop working because of an untreated illness, or they miss too many days at work because they can never go to a doctor and then lose their job or lose incomes from those days they don’t work — that can send a household into a spiral.  And then, once a household starts breaking down because they lose a home, or they lose a car, or they lose a job, now, suddenly, you start having people in shelters, and people on the streets.  And that then affects kids and then their capacity to learn.  And you then create cycles of problems that are much harder for people to pull out of.

So part of the reason that it’s important for us to get this health care issue right is so that people have at least a stable base from which to then focus on all the other issues that they’ve got to focus on in their lives.  And if we can, as I said before, continue to do a better job of providing high-quality care to everybody, but in a more efficient way, then that will free up resources so that, for example, we can address the underfunding of schools, and we can make sure that we are having additional resources inside the schools for things like mental health.

The number of under-diagnosed young people who end up getting in trouble or dropping out of school just because they didn’t get the same health care services that better-off families get, it’s substantial.  And once they’ve dropped out, you lose them.  And then they end up in the criminal justice system.  And we then end up paying for their incarceration instead of them paying taxes because they’re able to get a good job and support a family.  And those cycles can build.

One of the most challenging things as President for me is to try to get folks to recognize that investments in people oftentimes save us money over the long term, even if it looks like it costs money in the short term.  And we make this mistake over and over again.

You mentioned school lunches, for example.  We know that children’s grades and test scores tend to go down at the end of the month, on average, in low-income communities.  All right, well, why is that?  It’s because food stamps start running out at the end of the month and kids are hungry and they’re not focused.

Now, it may look smart for us to restrict those benefits, except if even half of those kids end up doing better in school, and didn’t drop out, and were able to get a job, the society would be much wealthier.  If we are focused on mental health services, then we could cut down on the crime rate.  If we invest in early childhood education, we know there are improved outcomes that save the society money as a whole.

And let’s face it, part of what prevents us from making those investments in the short term is, is that we’ve gone through some tough times.  The middle class feels strapped.  People’s incomes and wages haven’t gone up — even after the recovery where we dug ourselves out of the crisis.  We still have growing inequality where a huge amount of the increase in income is still going to folks at the very top.  And so if you’re a middle-class person, and you’re already struggling and things are tight, then sometimes you feel like, well, why am I going to pay more taxes to help folks at the bottom?  Right?  That’s, I think, the mentality that a lot of folks have.  And it’s understandable.

But part of what I’ve been trying to argue — and I know Jim tries to do it, as well — is to recognize that we don’t have to choose between middle-class families working hard and trying to get ahead and low-income families who are working hard and trying to get ahead — if those of us who’ve been extremely blessed are just a little more open-hearted about how we can help everybody. (Applause.)

And I would like us to just reflect the generosity of spirit that Margaret expresses, because if we all had that generosity of spirit, if we all look at every child as a member of our family, if we think of everybody as part of a single community, then we can solve a lot of these problems.  And it won’t end up costing us more money, we won’t necessarily have to pay more taxes, we’ll just be spending it in different ways.

In some ways, health care is a good metaphor for a lot of the problems we have.  We spend things on stuff we don’t need and we neglect the things we do, and we don’t end up healthier as a result.

Well, that’s not just true for the health care system; that’s true for our economy.  We waste a lot of money on stuff we don’t need.  And we under-invest in those things that will make sure that we have a healthy society.  And politics oftentimes gets in the way.  And part of what I’ve tried to encourage my own Democratic Party to do is to recognize that not all the money that we spend at the federal level is smart, and some of it — some programs don’t work and we should end those when they don’t work, and be honest about what’s working and what’s not.

But part of what I’ve also tried to do is to say to the Republican Party:  Open your hearts and think about the people here in Tennessee who are working hard, are struggling, and just need a little bit of help.  And if we give them that help, it’s going to pay off over the long term.  This will be a stronger state.  Employment will be higher.  Folks will be paying taxes.  Everybody is going to prosper.

We’re all in this together.  That’s what I believe.  When America is together and we have a certain generosity of spirit, even if we’re hard-headed about making sure stuff works right and we’re not wasting money, but we’re doing what is needed to give everybody a shot in life, that’s when America grows.  That’s when we prosper.

I know that’s what you believe, too, Margaret.  You showed it in your own life.  We appreciate you very much.

Thank you.  God bless you.  Thank you, everybody.  (Applause.)

END
2:44 P.M. CDT

Full Text Obama Presidency June 25, 2015: President Barack Obama’s Remarks on the Supreme Court’s Ruling in favor of Affordable Care Act Obamacare Federal Subsidies Transcript

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 114TH CONGRESS:

Remarks by the President on the Supreme Court’s Ruling of the Affordable Care Act

Source: WH, 6-25-15

Rose Garden

11:34 A.M. EDT

THE PRESIDENT:  Good morning, everybody.  Have a seat.  Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate — we finally declared that in America, health care is not a privilege for a few, but a right for all.

Over those five years, as we’ve worked to implement the Affordable Care Act, there have been successes and setbacks.  The setbacks I remember clearly.  (Laughter.)  But as the dust has settled, there can be no doubt that this law is working.  It has changed, and in some cases saved, American lives.  It set this country on a smarter, stronger course.

And today, after more than 50 votes in Congress to repeal or weaken this law; after a presidential election based in part on preserving or repealing this law; after multiple challenges to this law before the Supreme Court — the Affordable Care Act is here to stay.

This morning, the Court upheld a critical part of this law -– the part that’s made it easier for Americans to afford health insurance regardless of where you live.  If the partisan challenge to this law had succeeded, millions of Americans would have had thousands of dollars’ worth of tax credits taken from them.  For many, insurance would have become unaffordable again.  Many would have become uninsured again.  Ultimately, everyone’s premiums could have gone up.  America would have gone backwards.  And that’s not what we do.  That’s not what America does.  We move forward.

So today is a victory for hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law.

If you’re a parent, you can keep your kids on your plan until they turn 26 — something that has covered millions of young people so far.  That’s because of this law.

If you’re a senior, or an American with a disability, this law gives you discounts on your prescriptions — something that has saved 9 million Americans an average of $1,600 so far.

If you’re a woman, you can’t be charged more than anybody else — even if you’ve had cancer, or your husband had heart disease, or just because you’re a woman.  Your insurer has to offer free preventive services like mammograms.  They can’t place annual or lifetime caps on your care because of this law.

Because of this law, and because of today’s decision, millions of Americans who I hear from every single day will continue to receive the tax credits that have given about eight in ten people who buy insurance on the new marketplaces the choice of a health care plan that costs less than $100 a month.

And when it comes to preexisting conditions — someday, our grandkids will ask us if there was really a time when America discriminated against people who get sick.  Because that is something this law has ended for good.  That affects everybody with health insurance — not just folks who got insurance through the Affordable Care Act.  All of America has protections it didn’t have before.

As the law’s provisions have gradually taken effect, more than 16 million uninsured Americans have gained coverage so far.  Nearly one in three Americans who was uninsured a few years ago is insured today.  The uninsured rate in America is the lowest since we began to keep records.  And that is something we can all be proud of.

Meanwhile, the law has helped hold the price of health care to its slowest growth in 50 years.  If your family gets insurance through your job — so you’re not using the Affordable Care Act — you’re still paying about $1,800 less per year on average than you would be if we hadn’t done anything.  By one leading measure, what business owners pay out in wages and salaries is now finally growing faster than what they spend on health insurance.  That hasn’t happened in 17 years — and that’s good for workers and it’s good for the economy.

The point is, this is not an abstract thing anymore.  This is not a set of political talking points.  This is reality.  We can see how it is working.  This law is working exactly as it’s supposed to.  In many ways, this law is working better than we expected it to.  For all the misinformation campaigns, all the doomsday predictions, all the talk of death panels and job destruction, for all the repeal attempts — this law is now helping tens of millions of Americans.

And they’ve told me that it has changed their lives for the better.  I’ve had moms come up and say, my son was able to see a doctor and get diagnosed, and catch a tumor early, and he’s alive today because of this law.  This law is working.  And it’s going to keep doing just that.

Five years in, this is no longer about a law.  This is not about the Affordable Care Act as legislation, or Obamacare as a political football.  This is health care in America.

And unlike Social Security or Medicare, a lot of Americans still don’t know what Obamacare is beyond all the political noise in Washington.  Across the country, there remain people who are directly benefitting from the law but don’t even know it.  And that’s okay.  There’s no card that says “Obamacare” when you enroll.  But that’s by design, for this has never been a government takeover of health care, despite cries to the contrary.  This reform remains what it’s always been:  a set of fairer rules and tougher protections that have made health care in America more affordable, more attainable, and more about you — the consumer, the American people.  It’s working.

And with this case behind us, let’s be clear — we’ve still got work to do to make health care in America even better.  We’ll keep working to provide consumers with all the tools you need to make informed choices about your care.  We’ll keep working to increase the use of preventive care that avoids bigger problems down the road.  We’ll keep working to boost the steadily improving quality of care in hospitals, and bring down costs even lower, make the system work even better.  Already we’ve seen reductions, for example, in the number of readmissions at hospitals.  That saves our society money, it saves families money, makes people healthier.

We’re making progress.  We’re going to keep working to get more people covered.  I’m going to work as hard as I can to convince more governors and state legislatures to take advantage of the law, put politics aside, and expand Medicaid and cover their citizens.  We’ve still got states out there that, for political reasons, are not covering millions of people that they could be covering, despite the fact that the federal government is picking up the tab.

So we’ve got more work to do.  But what we’re not going to do is unravel what has now been woven into the fabric of America.  And my greatest hope is that rather than keep refighting battles that have been settled again and again and again, I can work with Republicans and Democrats to move forward.  Let’s join together, make health care in America even better.

Three generations ago, we chose to end an era when seniors were left to languish in poverty.  We passed Social Security, and slowly it was woven into the fabric of America and made a difference in the lives of millions of people.  Two generations ago, we chose to end an age when Americans in their golden years didn’t have the guarantee of health care.  Medicare was passed, and it helped millions of people.

This generation of Americans chose to finish the job — to turn the page on a past when our citizens could be denied coverage just for being sick.  To close the books on a history where tens of millions of Americans had no hope of finding decent, affordable health care; had to hang their chances on fate.  We chose to write a new chapter, where in a new economy, Americans are free to change their jobs or start a business, chase a new idea, raise a family, free from fear, secure in the knowledge that portable, affordable health care is there for us and always will be.  And that if we get sick, we’re not going to lose our home.  That if we get sick, that we’re going to be able to still look after our families.

That’s when America soars -– when we look out for one another.  When we take care of each other.  When we root for one another’s success.  When we strive to do better and to be better than the generation that came before us, and try to build something better for generations to come.  That’s why we do what we do.  That’s the whole point of public service.

So this was a good day for America.  Let’s get back to work.  (Applause.)

END
11:45 A.M. EDT

Full Text Political Transcripts June 25, 2015: King v. Burwell Supreme Court opinion ruling in favor of Obamacare federal subsidies

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 114TH CONGRESS:

SUPREME COURT OF THE UNITED STATES

KING ET AL v BURWELL, SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL

6/25/15 – King v. Burwell

Oral Arguments: March 4, 2015

  Transcript: 14-114. King v. Burwell 03/04/15
 Audio; 14-114. King v. Burwell 03/04/15

Full Text Obama Presidency June 9, 2015: President Barack Obama’s Speech at the Catholic Health Association Conference defending Obamacare — Transcript

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 114TH CONGRESS:

Remarks by the President at the Catholic Health Association Conference

Source: WH, 6-9-15 

Washington Marriott Wardman Park
Washington, D.C.

11:58 A.M. EDT

THE PRESIDENT:  Thank you.  (Applause.)  Thank you so much. (Applause.)  Everybody, please have a seat.  Thank you so much.

Well, I don’t know whether this is appropriate, but I just told Sister Carol I love her.  (Laughter.)  On a big stage.  It is true, though — I do.  She is just wonderful.  Her dedication to doing God’s work here on Earth, her commitment to serving “the least of these,” here steadiness, her strength, her steadfast voice have been an inspiration to me.  We would not have gotten the Affordable Care Act done had it not been for her.  I want to thank the entire Catholic Health Association for the incredible work you do.  (Applause.)

And it’s true, I just love nuns, generally.  (Laughter.)  I’m just saying.  (Laughter.)

It is an honor to join you on your 100th anniversary of bringing hope and healing to so many.  I want to acknowledge Dignity Health and its CEO, Lloyd Dean — (applause) — honored by the Catholic Health Association last night for his outstanding support of our efforts to improve health care in America.  He has been a great friend.

I want to thank Ascension Health, a great provider of care  — that also recently raised its minimum wage.  (Applause.)  I want to thank Secretary Burwell and the members of Congress who are here today, because they have been obviously doing extraordinary work.  (Applause.)

My first job in Chicago when I moved after college to work as a community organizer — my first job was funded by the Campaign for Human Development, an anti-poverty initiative of the Catholic Church.  And my first office was at Holy Rosary Church on the South Side of Chicago, across from Palmer Park.  (Applause.)  You’re clapping there — she knows Holy Rosary.  (Laughter.)  And the task was to work with parishes and neighbors and faith and community leaders to bring low-income people together, to stitch neighborhoods together, clergy and laypeople. And the work was hard, and there were times where it was dispiriting.  We had plenty of setbacks.  There were times where I felt like quitting, where I wondered if the path I’d chosen was too hard.

But despite these challenges, I saw how kindness and compassion and faith can change the arc of people’s lives.  And I saw the power of faith — a shared belief that every human being, made in the image of God, deserves to live in dignity; that all children, no matter who they are or where they come from or how much money they were born into, ought to have the opportunity to achieve their God-given potential; that we are all called, in the words of His Holiness Pope Francis, “to satisfy the demands of justice, fairness, and respect for every human being.”

And at the time, when I had just moved to Chicago, the Cardinal there was Cardinal Bernardin, an extraordinary man.  And he understood that part of that commitment, part of that commitment to the dignity of every human being also meant that we had to care about the health of every human being.  And he articulated that, and the Church articulated that, as we moved at the state level in the Illinois legislature, once I was elected there later on in life, to advance the proposition that health care is not a privilege, it is a right.

And that belief is at the heart of the Catholic Health Association’s mission.  For decades, your member hospitals have been on the front lines, often serving the marginalized, the vulnerable and the sick and the uninsured.  And that belief is at the heart of why we came together more than five years ago to reform our health care system — to guarantee that every American has access to quality, affordable care.

So I’m here today to say thank you for your tireless efforts to make health reform a reality.  Without your commitment to compassionate care, without your moral force, we would not have succeeded.  (Applause.)  We would not have succeeded had it not been for you and the foundation you had laid.  (Applause.)

And pursuing health care reform wasn’t about making good on a campaign promise for me.  It was, remember, in the wake of an economic crisis with a very human toll and it was integral to restoring the basic promise of America — the notion that in this country, if you work hard and you take responsibility, you can get ahead.  You can make it if you try.  Everything we’ve done these past six years and a half years to rebuild our economy on a new foundation — from rescuing and retooling our industries, to reforming our schools, to rethinking the way we produce and use energy, to reducing our deficits — all of that has been in pursuit of that one goal, creating opportunity for all people.  And health reform was a critical part of that effort.

For decades, a major barrier to economic opportunity was our broken health care system.  It exposed working families to the insecurities of a changing economy.  It saddled our businesses with skyrocketing costs that made it hard to hire or pay a good wage.  It threatened our entire nation’s long-term prosperity, was the primary driver of our deficits.

And for hospitals like yours, the fact that so many people didn’t have basic care meant you were scrambling and scratching every single day to try to figure out how do we keep our doors open.

Leaders from Teddy Roosevelt to Teddy Kennedy wanted to reform it.  For as long as there were Americans who couldn’t afford decent health care, as long as there were people who had to choose between paying for medicine or paying the rent, as long as there were parents who had to figure out whether they could sell or borrow to pay for a child’s treatment just a few months more, and beg for God’s mercy to make it work in time — as long as those things were happening, America was not living up to our highest ideals.

And that’s why providers and faith leaders like you called for expanding access to affordable care.  Every day, you saw the very personal suffering of those who go without it.  And it seemed like an insurmountable challenge.  Every time there was enough political will to alleviate that suffering and to reform the health care system — whether it was under Democratic Presidents or Republican Presidents — you had special interests arraying and keeping the status quo in place.  And each year that passed without reform the stakes kept getting higher.

By the time I took office, thousands of Americans were losing their health insurance every single day.  Many people died each year because they didn’t have health insurance.  Many families who thought they had coverage were driven into bankruptcy by out-of-pocket costs.  Tens of millions of our fellow citizens had no coverage at all in this, the wealthiest, most powerful nation on Earth.  And despite being the only advanced economy in the world without universal health care, our health care costs grew to be the most expensive in the world with no slowing in sight.  And that trend strained the budgets of families and businesses and our government.

And so we determined that we could not keep kicking that can down the road any longer.  We could not leave that problem for another generation to solve, or another generation after that.

And remember, this was not easy.  (Laughter.)  There were those who thought health care reform was too messy, and too complicated, and too politically risky.  I had pollsters showing me stuff, and 85 percent of folks at any given time had health care and so they weren’t necessarily incentivized to support it. And you could scare the heck out of them about even if they weren’t entirely satisfied with the existing system that somehow it would be terrible to change it.  All kinds of warning signs about how tough this was — bad politics.

But for every politician and pundit who said we should wait, why rush, barely a day went by where I didn’t hear from hardworking Americans who didn’t have a moment left to lose.  These were men and women from all backgrounds, all walks of life, all races, all faiths, in big cities, small towns, red states, blue states.  Middle-class families with coverage that turned out not to be there for them when they needed it.  Moms and dads desperately seeking care for a child with a chronic illness only to be told “no” again and again — or fearful as their child got older, what was there future going to be because they weren’t going to be able to get insurance once they left the house.  Small business owners forced to choose between insuring their employees and keeping the “open” sign hanging in the window.

And every one of these stories tugged at me in a personal way — because I spoke about seeing my mom worry about how she was going to deal with her finances when she got very sick.  And I was reminded of the fear that Michelle and I felt when Sasha was a few months old and we had to race to the hospital, in the emergency room learning that she had meningitis — that we caught only because we had a wonderful pediatrician and regular care.  Never felt so scared or helpless in my life.

We were fortunate enough to have good health insurance.   And I remember looking around in that emergency room and thinking what about the parents who aren’t that lucky?  What about the parents who get hit with a bill of $20,000 or $30,000, and they’ve got no idea how to pay for it?  What about those parents with kids who have a chronic illness like asthma and have to keep going back to the emergency room because they don’t have a regular doctor, and the bills never stop coming?  Who’s going to stand up for them?

Behind every single story was a simple question:  What kind of country do we want to be?  Are we a country that’s defined by values that say access to health care is a commodity awarded to only the highest bidders, or by the values that say health care is a fundamental right?  Do we believe that where you start should determine how far you go, or do we believe that in the greatest nation on Earth, everybody deserves the opportunity to make it — to make of their lives what they will?

The rugged individualism that defines America has always been bound by a shared set of values, an enduring sense that we’re in this together, that America is not a place where we simply turn away from the sick, or turn our backs on the tired, the poor, the huddled masses.  It is a place sustained by the idea:  I am my brother’s keeper.  I am my sister’s keeper — that we have an obligation to put ourselves in our neighbor’s shoes and see each other’s common humanity.

And so, after a century of talk, after decades of trying, after a year of sustained debate, we finally made health care reform a reality here in America.  (Applause.)

And despite the constant doom-and-gloom predictions, the unending Chicken Little warnings that somehow making health insurance fairer and easier to buy would lead to the end of freedom, the end of the American way of life — lo and behold, it did not happen.  None of this came to pass.  In fact, in a lot of ways, the Affordable Care Act worked out better than some of us anticipated.

Nearly one in three uninsured Americans have already been covered — more than 16 million people -– driving our uninsured rate to its lowest level ever.  (Applause.)  Ever.  On top of that, tens of millions more enjoy new protections with the coverage that they’ve already got.  That 85 percent who had health insurance, they may not know that they’ve got a better deal now than they did, but they do.  Americans can no longer be denied coverage because of preexisting conditions — from you having had cancer to you having had a baby.  Women can’t be charged more just for being a woman.  (Applause.)  And they get free preventive services like mammograms.  And there are no more annual or lifetime caps on the care patients receive.

Medicare has been strengthened and protected.  We’ve added 13 years to its actuarial life.  The financial difference for business owners trying to invest and grow, and the families trying to save and spend — that’s real, too.  Health care prices have risen at the lowest rate in 50 years.  Employer premiums are rising at a rate tied for the lowest on record.  The average family premium is $1,800 lower today than it would have been had trends over the decade before the ACA passed continued.

In the years to come, countless Americans who can now buy plans that are portable and affordable on a competitive marketplace will be free to chase their own ideas, unleash new enterprises across the country, knowing they’ll be able to buy health insurance.

And here’s the thing — that security won’t just be there for us.  It will be there for our kids as they go through life.  When they graduate from college, they’re looking for that first job, they can stay on our plans until they’re 26.  When they start a family, pregnancy will no longer count against them as a preexisting condition.  When they change jobs or lose a job, or strike out on their own to start a business, they’ll still be able to get good coverage.  They’ll have that peace of mind all the way until they retire into a Medicare that now has cheaper prescription drugs and wellness visits to make sure that they stay healthy.

And while we were told again and again that Obamacare would be a job-killer — amazingly enough, some critics still peddle this notion — it turns out in reality, America has experienced 63 straight months of private sector job growth — a streak that started the month we passed the Affordable Care Act.  (Applause.) The longest streak of private sector job growth on record — that adds up to 12.6 million new jobs.  (Applause.)

So the critics stubbornly ignore reality.  In reality, there is a self-employed single mom of three who couldn’t afford health insurance until health reform passed and she qualified for Medicaid in her state.  And she was finally able to get a mammogram, which detected early-stage breast cancer and may have saved her life.  That’s the reality, not the mythology.

In reality, there are parents in Texas whose autistic son couldn’t speak.  Even with health insurance, they struggled to pay for his treatment.  But health reform meant they could buy an affordable secondary plan that covered therapy for their son — and today, that little boy can tell his parents that he loves them.  That’s the reality.  (Applause.)

In reality, there’s a self-employed barber from Tennessee — who happens to be a Republican — who couldn’t afford health insurance until our new marketplace opened up.  And once he bought a plan, he finally went to the doctor and was diagnosed with esophageal cancer.  In the old days, without coverage, he wouldn’t have even known that he was sick.  And today, he’s now cancer-free.

So five years in, what we are talking about it is no longer just a law.  It’s no longer just a theory.  This isn’t even just about the Affordable Care Act or Obamacare.  This isn’t about myths or rumors that folks try to sustain.  There is a reality that people on the ground day to day are experiencing.  Their lives are better.

This is now part of the fabric of how we care for one another.  This is health care in America — which is why, once you get outside of Washington and leave behind the Beltway chatter and the politics, Americans support this new reality.  When you talk to people who actually are enrolled in a new marketplace plan, the vast majority of them like their coverage. The vast majority are satisfied with their choice of doctors and hospitals and satisfied with their monthly premiums.  They like their reality.

Now, that doesn’t mean that we don’t have more work to do.  Sister Carol and I were talking backstage — we know we got more work to do.  Like any serious attempt at change, there were disruptions in the rollout, there are policies we can put in place to make health care work even better.  Secretary Burwell is talking about all the things we have to do together around delivery system reform.  We have to protect the coverage that people have now and sign even more people up.  We need more governors and state legislatures to expand Medicaid, which was a central part of the architecture of the overall plan.  We have to continue to improve the quality of care.  And we know we can still bring down costs.

And none of this is going to be easy.  Nobody suggests that somehow our health care system is perfect as a consequence of the law being passed, but it is serving so many more people so much better.  And we’re not going to go backwards.  There’s something, I have to say, just deeply cynical about the ceaseless, endless partisan attempts to roll back progress.  I mean, I understood folks being skeptical or worried before the law passed and there wasn’t a reality there to examine.  But once you see millions of people of having health care, once you see that all the bad things that were predicted didn’t happen, you’d think that it would be time to move one.

Let’s figure out how to make it better.  It seems so cynical to want to take coverage away from millions of people; to take care away from people who need it the most; to punish millions with higher costs of care and unravel what’s now been woven into the fabric of America.

And that kind of cynicism flies in the face of our history.  Our history is one of each generation striving to do better and to be better than the last.  Just as we’ll never go back to a time when seniors were left to languish in poverty or not have any health insurance in their golden years.  There was a generation that didn’t have that guarantee of health care.  We’re not going to go back to a time when our citizens can be denied coverage because of a preexisting condition.  When tens of millions of people couldn’t afford decent, affordable care — that wasn’t a better America.  That’s not freedom.  The freedom to languish in illness, or to be bankrupt because somebody in your family gets stick — that’s not who we are.  That’s not what we’re about.

Debra Lea Oren of Pennsylvania knows that.  Debra suffers from osteoarthritis that was so severe that it put her in a wheelchair.  And for years she couldn’t stand or walk at all, and was in constant pain — through no fault of her own, just the twists and turns of life.  And without health insurance to get treatment, it seemed as though she might never again live a life that was full.  Today, Debra is enrolled in affordable health coverage, was able to have surgery to replace her knees.  She’s back on her feet.  She walks her dogs, shops at the grocery store, gets to her doctor’s appointments.  She’s cooking, she’s exercising, regaining her health.

Debra couldn’t be here today, but she recently wrote to me and she said:  “I walk with my husband Michael and hold hands.  It’s like a whole new world for me.”  Just walking and holding hands — something that one of our fellow Americans for years could not do.

Every day, miracles happen in your hospitals.  But remaking Debra’s world didn’t require a miracle.  It just required that Debra have access to something that she and every other American has a right to expect, which is health care coverage.

And while there are outcomes that we can calculate and enumerate — the number of newly insured families, the number of lives saved — those numbers all add up to success in this reform effort.  But there are also outcomes that are harder to calculate — in the tally of pain and tragedy and bankruptcies that have been averted, but also in the security of a parent who can afford to take her kid to the doctor; or the dignity of a grandfather who can get the preventive care that he needs; or the freedom of an entrepreneur who can start a new venture — or the joy of a wife who thought she’d never again take her husband’s hand and go for a walk.

In the end, that’s why you do what you do.  Isn’t that what this is all about?  Is there any greater measure of life and liberty and the pursuit of happiness than those simple pleasures that are afforded because you have good health and you have some security?

More than five years ago, I said that while I was not the first President to take up this cause, I was determined to be the last.  And now it’s up to all of us — the citizens in this room and across the country- — to continue to help make the right to health care a reality for all Americans.  And if we keep faith with one another and keep working for each other to create opportunity for everybody who strives for it, then, in the words of Senator Ted Kennedy, “the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.”
It couldn’t have happened without you.  (Applause.)

Thank you.  God bless you all.  Thank you so much.  (Applause.)

END
12:25 P.M. EDT

Full Text Obama Presidency March 25, 2015: President Barack Obama’s Speech Marking the Fifth Anniversary of the Affordable Care Act

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 114TH CONGRESS:

Remarks by the President Marking the Fifth Anniversary of the Affordable Care Act

Source: WH, 3-25-15

South Court Auditorium

10:42 A.M. EDT

THE PRESIDENT:  Thank you.  (Applause.)  Thank you so much, everybody.   Everybody, have a seat.  Thank you, Doctor, for that introduction.  I want to thank Sylvia Burwell, our outstanding head of Health and Human Services.  We’ve got some wonderful members of Congress here today who helped make this happen.  And I want to offer a heartfelt thanks to all of the top medical professionals who are here today.  We’ve got hospital leaders, we’ve got health care CEOs, doctors, patients, advocates, consumer groups, Democrats and Republicans, who have all come together and spent time and effort to make the Affordable Care Act, and America’s health care system, work even better.

What your efforts have meant is the start of a new phase, where professionals like you and organizations like yours come together in one new network with one big goal, and that is to continue to improve the cost and quality of health care in America.

A lot of you have already taken steps on your own.  The American Cancer Society that’s represented here is committed to teaching its members about how new patient-centered approaches can improve cancer care.  Governor Markell of Delaware, who’s here, has set a goal of having 80 percent of his citizens receive care through new and improved payment and delivery models within five years.  And Dr. Glenn Madrid, of Grand Junction, Colorado, is using a new care model that allowed him to hire case coordinators and use better technology so that patients have access to him 24/7.  I don’t know when that lets him sleep — but his patients are sleeping better.

And these are examples of efforts that show we don’t need to reinvent the wheel; you’re already figuring out what works to reduce infections in hospitals or help patients with complicated needs.  What we have to do is to share these best practices, these good ideas, including new ways to pay for care so that we’re rewarding quality.  And that’s what this network is all about.

In fact, just five years in, the Affordable Care Act has already helped improve the quality of health care across the board.  A lot of the attention has been rightly focused on people’s access to care, and that obviously was a huge motivator for us passing the Affordable Care Act — making sure that people who didn’t have health insurance have the security of health insurance.

But what was also a central notion in the Affordable Care Act was we had an inefficient system with a lot of waste that didn’t also deliver the kind of quality that was needed that often put health care providers in a box where they wanted to do better for their patients, but financial incentives were skewed the other way.

And so the work that we’ve been able to do is already spurring the kinds of changes that we had hoped for.  It’s helped reduce hospital readmission rates dramatically.  It’s a major reason why we’ve seen 50,000 fewer preventable patient deaths in hospitals.  And if you want to know what that means, ask Alicia Cole, who suffers — Alicia is right here — who suffers the long-term effects of a hospital-acquired infection.  And she is here today because she doesn’t want anybody else to endure what she has.  And it’s preventable if we set up good practices, and financial incentives, reimbursement incentives, are aligned with those best practices.

So making sure that the Affordable Care Act works as intended, to not only deliver access to care but also to improve the quality of care and the cost of care, that’s something that requires all of us to work together.  That’s part of what the law is all about.  It’s making health coverage more affordable and more effective for all of us.  And in a lot of ways, it’s working better than many of us, including me, anticipated.  (Laughter.)

Wherever you are, here’s why you should care about making this system more efficient, and here’s why you should care that we keep the Affordable Care Act in place.

If you get insurance through your employer, like most Americans do, the ACA gave you new savings and new protections.  If you’ve got a pre-existing condition like diabetes or cancer, if you’ve had heartburn or a heart attack, this law means that you can no longer be charged more or denied coverage because of a preexisting condition, ever.  It’s the end of the discrimination against the sick in America, and all of us are sick sometimes.

If you don’t have health insurance, you can go online to the marketplace and choose from an array of quality, affordable private plans.  Every governor was given the option to expand Medicaid for his or her citizens, although only 28 have chosen to do so — so far.  But after five years of the ACA, more than 16 million uninsured Americans have gained health care coverage — 16 million.  In just over one year, the ranks of the uninsured have dropped by nearly one-third — one-third.

If you’re a woman, you can no longer be charged more just for being a woman.  And you know there are a lot of women.  (Laughter.)  Like more than 50 percent.  (Laughter.)  Preventive care, like routine checkups and immunizations and contraception now come with no additional out-of-pocket costs.

If you’re a young person, you can now stay on your parents’ plan until you turn 26.  And if you want to turn that new idea into a business, if you’re going to try different jobs, even a different career, you now have the freedom to do it because you can buy health care that’s portable and not tied to your employer.  Most people have options that cost less than 100 bucks a month.

If you’re a business owner — because when we put forward the Affordable Care Act, there was a lot of question about how it would affect business; well, it turns out employer premiums rose at a rate tied for the lowest on record.  If premiums had kept growing at the rate we saw in the last decade, then either the average family premium, paid by the family or paid by the business, would be $1,800 higher than it is today.  That’s 1,800 bucks that businesses can use to higher and invest, or that’s 1,800 bucks that stays in that family’s bank account, shows up in their paycheck.

If you’re a senior — more than 9 million seniors and people with disabilities have saved an average of $1,600 on their prescriptions, adding up to over $15 billion in savings.  There were fears promoted that somehow this was going to undermine Medicare.  Well, it turns out the life of the Medicare Trust Fund has been extended by 13 years since this law has passed.

And, relevant to the topic today, we’re moving Medicare toward a payment model that rewards quality of care instead of quantity of care.  We don’t want the incentives to be skewed so that providers feel obliged to do more tests; we want them to do the right tests.  We want them, perhaps, to save — to invest some money on the front end to prevent disease and not just on the back end to treat disease.  And so these changes are encouraging doctors and hospitals to focus on getting better outcomes for their patients.

As we speak, Congress is working to fix the Medicare physician payment system.  I’ve got my pen ready to sign a good, bipartisan bill — (applause) — which would be really exciting.  I love when Congress passes bipartisan bills that I can sign.  (Laughter.)  It’s always very encouraging.  And I want to thank everybody here today for their work in supporting new models of care that will benefit all Americans.

But the bottom line is this for the American people:  The Affordable Care Act, this law, is saving money for families and for businesses.  This law is also saving lives — lives that touch all of us.  It’s working despite countless attempts to repeal, undermine, defund, and defame this law.

It’s not the “job-killer” that critics have warned about for five years.  When this law was passed, our businesses began the longest streak of private-sector job growth on record:  60 straight months, five straight years, 12 million new jobs.

It’s not the fiscal disaster critics warned about for five years.  Health care prices are rising at the slowest rate in nearly 50 years, which has helped cut our deficit by two-thirds since I took office.  Before the ACA, health care was the single biggest driver driving up our projected deficits.  Today, health care is the single biggest factor driving those projections down.

I mean, we have been promised a lot of things these past five years that didn’t turn out to be the case:  death panels, doom.  (Laughter.)  A serious alternative from Republicans in Congress.  (Laughter.)

The budget they introduced last week would literally double the number of the uninsured in America.  And in their defense, there are two reasons why coming up with their own alternative has proven to be difficult.

First, it’s because the Affordable Care Act pretty much was their plan before I adopted it — (laughter) — based on conservative, market-based principles developed by the Heritage Foundation and supported by Republicans in Congress, and deployed by a guy named Mitt Romney in Massachusetts to great effect.  If they want to take credit for this law, they can.  I’m happy to share it.  (Laughter.)

And second, it’s because health reform is really hard and the people here who are in the trenches know that.  Good people from both parties have tried and failed to get it done for 100 years, because every public policy has some trade-offs, especially when it affects one-sixth of the American economy and applies to the very personal needs of every individual American.

And we’ve made our share of mistakes since we passed this law.  But we also know beyond a shred of a doubt that the policy has worked.  Coverage is up.  Cost growth is at a historic low.  Deficits have been slashed.  Lives have been saved.  So if anybody wants to join us in the spirit of the people who have put aside differences to come here today and help make the law work even better, come on board.

On the other hand, for folks who are basing their entire political agenda on repealing the law, you’ve got to explain how kicking millions of families off their insurance is somehow going to make us more free.  Or why forcing millions of families to pay thousands of dollars more will somehow make us more secure.  Or why we should go back to the days when women paid more for coverage than men.  Or a preexisting condition locked so many of us out of insurance.

And if that’s your argument, then you should meet somebody like Anne Ha, who is here.  Anne is 28 years old.  Where’s Anne?  There you are.  Anne runs her own business in Philadelphia.  And she thought what many of us think when we’re young — I no longer qualify — (laughter) — that she was too young, too healthy to bother with health insurance.  She went to the gym every day.  She ate healthy, looks great, felt invincible.  Why pay a doctor just to tell her she’s okay?

But then her mom called, as moms sometimes do, and told Anne to get insured against the “what ifs” of life.  What if you get sick?  What if you get into a car accident?  So Anne, dutiful daughter that she was, went to HealthCare.gov, checked out her options in the marketplace.  And thanks to the tax credits available to her under this law, she got covered for 85 bucks a month.  Four months later, Anne was diagnosed with early-stage stomach cancer.  Anne underwent surgery, endured chemo.  Today, she’s recovering.  She looks great.  She’s here with us at the White House.  She invited me to her wedding.  I told her you don’t want the President at her wedding.  (Laughter.)

“If I didn’t have insurance,” Anne wrote, “my stomach cancer would have gone undiscovered, slowly and silently killing me.  But because I did have insurance, I was given a chance to live a long and happy life.”  (Applause.)

And so in September, Anne is going to be marrying her fiancé, Tom.  And she’s convinced him to get covered, too.  And I do appreciate, Michelle appreciates the invitation.  As I said, we have to mag people at the wedding, and it spoils the fun.  (Laughter.)

But here are two lessons from Anne’s story.  Number one:  Listen to your mom.  (Laughter.)  Number two:  The Affordable Care Act works.  And it’s working not just to make sure that folks like Anne get coverage, but it’s also working to make sure that the system as a whole is providing better quality at a better price, freeing up our providers to do the things that led them to get into health care in the first place — and that’s help people.  It works.

Five years ago, we declared that in the United States of America, the security of quality, affordable health care was a privilege — was not a privilege, but a right.  And today, we’ve got citizens all across the country, all of you here today who are helping make that right a reality for every American, regardless of your political beliefs, or theirs.  And we’re saving money in the process.  And we’re cutting the deficit in the process.  And we’re helping businesses in their bottom lines in the process.  We’re making this country more competitive in the process.

And it’s not going to happen overnight.  There are still all kinds of bumps along the way.  Health care is complicated stuff.  And the hospital executives who are here, and the doctors who are here, and the consumer advocates who are here can tell you — all the complications and the quirks not just to the Affordable Care Act, but just generally making the system more rational and more efficient, it takes some time.  But we’re on our way.  We’re making progress.

And if all of us summon the same focus, the same kind of courage and wisdom and hard work that so many of you in this room display; and if we keep working not against one another, but for one another, with one another, we will not just make progress in health care.  We’re going to keep on making sure that across the board we’re living up to our highest ideals.

So I very much am appreciative of what all of you are doing.  I’m very proud of you.  And why don’t you guys get back to work?  (Laughter.)  Thank you very much.  (Applause.)

END
10:59 A.M. EDT

Political Musings November 7, 2014: Boehner warns Obama he would be “burned” for immigration reform executive action

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OBAMA PRESIDENCY & THE 113TH CONGRESS:

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Political Musings November 6, 2014: Ever defiant Obama knocks down McConnell olive branch vows executive actions

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OBAMA PRESIDENCY & THE 113TH CONGRESS:

Ever defiant Obama knocks down McConnell olive branch vows executive actions

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President Barack Obama held his first post-midterm elections press conference in the White House East Room on Wednesday, Nov. 5, 2014. The president said he heard voters after his Democratic Party’s historic losses, but with his…READ MORE

Political Musings April 22, 2014: Obama announces at press conference that Obamacare reached 8 million enrollees

POLITICAL MUSINGS

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OBAMA PRESIDENCY & THE 113TH CONGRESS:

OP-EDS & ARTICLES

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Full Text Obama Presidency April 17, 2014: President Barack Obama’s Press Conference on Reaching 8 Million Obamacare Enrollees and the Crisis in Ukraine

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 113TH CONGRESS:

Press Conference by the President, 4/17/14

Source: WH, 4-17-14

REMARKS BY THE PRESIDENT
AT PRESS CONFERENCE

James S. Brady Press Briefing Room

**Please see below for a correction marked with asterisks.

3:40 P.M. EDT

THE PRESIDENT:  Hello, everybody.  Before I begin I just want to express on behalf of the American people our deepest condolences to the Republic of Korea and the families of all those who’ve seen their loved ones lost when a ferry sank within the last couple of days.

Obviously, information is still coming in.  We know that many of the victims of this terrible tragedy were students.  And American Navy personnel and Marines have already been on the scene helping the search and rescue.  As one of our closest allies, our commitment to South Korea is unwavering in good times and in bad, and that’s something I’ll underscore during my visit to Seoul next week.

Before I take questions I’d also like to say a few words about how the Affordable Care Act is now covering more people at less cost than most would have predicted just a few months ago.

The first open enrollment period under this law ended a little over two weeks ago.  And as more data comes in, we now know that the number of Americans who’ve signed up for private insurance in the marketplaces has grown to 8 million people — 8 million people.  Thirty-five percent of people who enrolled through the federal marketplace are under the age of 35.  All told, independent experts now estimate that millions of Americans who were uninsured have gained coverage this year — with millions more to come next year and the year after.

We’ve also seen signs that the Affordable Care Act is bringing economic security to more Americans.  Before this law added new transparency and competition to the individual market, folks who bought insurance on their own regularly saw double-digit increases in their premiums.  That was the norm.  And while we suspect that premiums will keep rising, as they have for decades, we also know that since the law took effect health care spending has risen more slowly than at any time in the past 50 years.

In the decade before the Affordable Care Act, employer-based insurance rose almost 8 percent a year.  Last year, it grew at half that rate.  Under this law, real Medicare costs per person have nearly stopped growing.  The life of the Medicare Trust Fund has been extended by 10 years.  And the independent Congressional Budget Office now expects premiums for plans on the marketplace to be 15 percent lower than originally predicted.

So those savings add up to more money that families can spend at businesses, more money that businesses can spend hiring new workers.  And the CBO now says that the Affordable Care Act will be cheaper than recently projected.  Lower costs from  coverage provisions will shrink our deficits by an extra $100 billion.

So the bottom line is, under the Affordable Care Act, the share of Americans with insurance is up, the growth of health care costs is down.  Hundreds of millions of Americans who already have insurance now have new benefits and protections from free preventive care to freedom from lifetime caps on your care.  No American with a preexisting condition like asthma or cancer can be denied coverage.  No woman can be charged more just for being a woman.  Those days are over.  And this thing is working.

I’ve said before, this law won’t solve all the problems in our health care system.  We know we’ve got more work to do.  But we now know for a fact that repealing the Affordable Care Act would increase the deficit, raise premiums for millions of Americans, and take insurance away from millions more — which is why, as I’ve said before, I find it strange that the Republican position on this law is still stuck in the same place that it has always been.

They still can’t bring themselves to admit that the Affordable Care Act is working.  They said nobody would sign up; they were wrong about that.  They said it would be unaffordable for the country; they were wrong about that.  They were wrong to keep trying to repeal a law that is working when they have no alternative answer for millions of Americans with preexisting conditions who would be denied coverage again, or every woman who would be charged more for just being a woman again.

I know every American isn’t going to agree with this law.  But I think we can agree that it’s well past time to move on as a country and refocus our energy on the issues that the American people are most concerned about — and that continues to be the economy.  Because these endless, fruitless repeal efforts come at a cost.  The 50 or so votes Republicans have taken to repeal this law could have been 50 votes to create jobs by investing in things like infrastructure or innovation.  Or 50 votes to make it easier for middle-class families to send their kids to college.  Or 50 votes to raise the minimum wage, or restore unemployment insurance that they let expire for folks working hard to find a new job.

The point is the repeal debate is and should be over.  The Affordable Care Act is working.  And I know the American people don’t want us spending the next two and a half years refighting the settled political battles of the last five years.  They sent us here to repair our economy, to rebuild our middle class, and to restore our founding promise of opportunity — not just for a few, but for all.  And as President, that’s exactly what I intend to keep doing as long as I’m in this office.

With that, I’ll take some questions.  Let’s see who we got.  Kathleen Hennessey of the LA Times.

Q    Thanks, Mr. President.  It sounds like there’s been some development in the Ukraine talks in Geneva.  I’m just wondering if you could describe your level of confidence in what this agreement is and how you can be sure that Russia will follow through, given some of the remarks from President Putin this morning.

THE PRESIDENT:  I don’t think we can be sure of anything at this point.  I think there is the possibility, the prospect that diplomacy may deescalate the situation and we may be able to move towards what has always been our goal, which is let the Ukrainians make their own decisions about their own lives.

There was a meeting in Geneva — representatives of the Ukrainian government, the Russian government, the EU, as well as the United States.  It was a lengthy, vigorous conversation.  My understanding is, is that the Ukrainian Prime Foreign** Minister gave a detailed and thorough presentation about the reforms that they intend to introduce, including reforms that provide assurances for Ukrainians who live in eastern and southern Ukraine that they will be fully represented, that their rights will be protected, that Russian speakers and Russian natives in Ukraine will have the full protection of the law.  And my understanding, based on what I’ve heard, is that there was an acknowledgement within the meeting that the Ukrainian government in Kyiv had gone out of its way to address a range of the concerns that may have existed in southern and eastern Ukraine.

There was a promising public statement that indicated the need to disarm all irregular forces and militias and groups that have been occupying buildings.  There was an offer of amnesty to those who would willingly lay down their arms, evacuate those buildings, so that law and order could be restored in eastern and southern Ukraine.

The Russians signed on to that statement.  And the question now becomes will, in fact, they use the influence that they’ve exerted in a disruptive way to restore some order so that Ukrainians can carry out an election, move forward with the decentralization reforms that they’ve proposed, stabilize their economy, and start getting back on the path of growth and democracy and that their sovereignty will be respected.

We’re not going to know whether, in fact, there’s follow-through on these statements for several days.  And so today I spoke with Chancellor Merkel; later on in the day I’m going to be speaking to David Cameron.  We’re going to be consulting with our European allies.  Over the last week, we have put in place additional consequences that we can impose on the Russians if we do not see actual improvement of the situation on the ground.  And we are coordinating now with our European allies.

My hope is that we actually do see follow-through over the next several days.  But I don’t think given past performance that we can count on that, and we have to be prepared to potentially respond to what continue to be efforts of interference by the Russians in Eastern and Southern Ukraine.

If, in fact, we do see improvements, then that will obviously be a positive.  In the meantime, we’re going to make sure that we continue to help the Ukrainian government — working with the IMF, the Europeans and others — to stabilize their economy and to start reforming it.  We’re going to continue to work with our NATO allies to make sure that they are assured that we’re going to meet our Article 5 obligations and that they are secure.

And as I’ve said before — I think I had an interview with Major yesterday in which I mentioned this whole exercise by the Russians is not good for Russia either.  There are, I think, a number of articles today indicating the degree to which an economy that was already stuck in the mud is further deteriorating because of these actions.

And in my conversations with President Putin, I’ve emphasized the same thing, that we have no desire to see further deterioration of the Russian economy.  On the other hand, we are going to continue to uphold the basic principle of sovereignty and territorial integrity for all countries; and that there’s a way for Ukraine to be independent, to be sovereign, and to have positive relationships with both the West and the East, with both its European neighbors and its Russian neighbors.  And that’s our primary concern.

Maria Peña, La Opinión.

Q    Thank you, Mr. President.  I’ve got a hot spot for you here in the U.S.  House Majority Leader Eric Cantor said — or claimed that you haven’t learned how to work with them.  And he’s angry that you’re attacking the GOP on the lack of movement on immigration reform.  So I was wondering how you respond to that.

And the second part to that, right now you have hunger strikers across the street demanding relief for undocumented immigrants.  And I was wondering if you can dispel the rumors or if there’s a leak from the White House that you will make some sort of announcement in the coming weeks to expand that relief for the undocumented.  Thank you.

THE PRESIDENT:  Well, I actually had a very pleasant conversation with Mr. Cantor yesterday.

Q    Really?

THE PRESIDENT:  I did.  (Laughter.)  You’re always kind of surprised by the mismatch between press releases and the conversation.  I wished him happy Passover.  And what I said to him privately is something that I would share with him — that I’ve said publicly, which is there is bipartisan support for comprehensive immigration reform.  It would strengthen our economy, it would help with our security, and it would provide relief to families who — many of whom have lived here for years and who have children and family members who are U.S. citizens; and that Congress should act; and that right now what’s holding us back is House Republican leadership not willing to go ahead and let the process move forward.

So it was a pretty friendly conversation.  I think in his press release, I gather he was referring to the observation that we’d made a day earlier that it had now been a year since the Senate had passed a strong bipartisan bill, and that although we had heard a lot of talk about the House Republicans being interested in doing something, nothing had happened yet, and suggesting that we need some urgency here.  I still feel the same way.

I know there are Republicans in the House, as there are Republicans in the Senate, who know this is the right thing to do.  I also know it’s hard politics for Republicans because there are some in their base that are very opposed to this.  But what I also know is that there are families all across the country who are experiencing great hardship and pain because this is not getting resolved.  I also know that there are businesses around the country that could be growing even faster, that our deficits could be coming down faster, that we would have more customers in our shops, if we get this thing resolved.

We know what the right thing to do is.  It’s a matter of political will.  It’s not any longer a matter of policy.  And I’m going to continue to encourage them to get this done.

As far as our actions, Jeh Johnson, our new head of the  Department of Homeland Security, has been talking to everybody  — law enforcement, immigrant rights groups — to do a thorough-going review of our approach towards enforcement.  And we’re doing that in consultation with Democrats and Republicans and with any interested party.

I do think that the system we have right now is broken.  I’m not alone in that opinion.  The only way to truly fix it is through congressional action.  We have already tried to take as many administrative steps as we could.  We’re going to review it one more time to see if there’s more that we can do to make it more consistent with common sense and more consistent with I think the attitudes of the American people, which is we shouldn’t be in the business necessarily of tearing families apart who otherwise are law-abiding.

And so let me —

Q    Do you have a time?

THE PRESIDENT:  I won’t get into timing right now because Mr. Johnson is going to go ahead and do that review.

Tamara Keith.

Q    So you — regarding the Affordable Care Act, I think you —

THE PRESIDENT:  Yes, let’s talk about that.  (Laughter.)

Q    Since you brought it up.  (Laughter.)  I think everyone agrees that it has flaws.  But Democrats have been sort of reluctant in Congress to reopen the conversation, and Republicans have been more than happy to reopen the conversation but in a different way.  Now that, as you say, it’s here to stay, there are so many people that signed up, in this environment is it possible to do the kind of corrections that the business community and many others would like to see — sort of small, technical corrections?

THE PRESIDENT:  It is absolutely possible, but it will require a change in attitude on the part of the Republicans.

I have always said from the outset that on any large piece of legislation like this, there are going to be things that need to be improved, need to be tweaked.  I said that I think the day I signed the bill.  And I don’t think there’s been any hesitation on our part to consider ideas that would actually improve the legislation.  The challenge we have is, is that if you have certain members in the Republican Party whose view is making it work better is a concession to me, then it’s hard in that environment to actually get it done.

And I recognize that their party is going through the stages of grief — anger and denial and all that stuff — and we’re not at acceptance yet.  But at some point, my assumption is, is that there will be an interest to figure out how do we make this work in the best way possible.

We have 8 million people signed up through the exchanges.  That doesn’t include the 3 million young people who are able to stay on their parents’ plan.  It doesn’t include the 3 million people who benefited from expansions to Medicaid.  So if my math is correct, that’s 14 million right there.  You’ve got another 5 million people who signed up outside of the marketplaces but are part of the same insurance pool.  So we’ve got a sizable part of the U.S. population now in the first — for the first time in many cases, in a position to enjoy the financial security of health insurance.

And I’m meeting them as I’m on the road.  I saw a woman yesterday — young woman, maybe 34, with her mom and her dad, and she’s got two small kids and self-employed husband, and was diagnosed with breast cancer.  And this isn’t an abstraction to her.  She is saving her home.  She is saving her business.  She is saving her parents’ home, potentially, because she’s got health insurance, which she just could not afford.

And the question now becomes if, in fact, this is working for a lot of people but there are still improvements to make, why are we still having a conversation about repealing the whole thing, and why are we having folks say that any efforts to improve it are somehow handing Obama a victory?  This isn’t about me.  And my hope is, is that we start moving beyond that.  My suspicion is that probably will not happen until after November because it seems as if this is the primary agenda item in the Republican political platform.

But here’s what I know:  The American people would much rather see us talk about jobs, would much rather see us talk about high college costs, would much rather see us discussing how we can rebuild our roads and our bridges and our infrastructure and put people back to work.  They’d much rather see us talk about how we’d boost wages and boost incomes and improve their individual family bottom lines.

And if the Republicans want to spend the entire next six months or year talking about repealing a bill that provides millions of people health insurance without providing any meaningful alternative, instead of wanting to talk about jobs and the economic situation of families all across the country, that’s their prerogative.  At some point I think they’ll make the transition.  That’s my hope, anyway.  If not, we’re just going to keep on doing what we’re doing, which is making it work for people all across the country.

I’m sorry, I’m going to say one last thing about this, just because this does frustrate me:  States that have chosen not to expand Medicaid for no other reason than political spite.  You’ve got 5 million people who could be having health insurance right now at no cost to these states — zero cost to these states — other than ideological reasons.  They have chosen not to provide health insurance for their citizens.  That’s wrong.  It should stop.  Those folks should be able to get health insurance like everybody else.

Isaac, from Politico.  Where are you, Isaac?  There you are.

Q    Thank you, Mr. President.  Given all that you were just saying about the Affordable Care Act, do you think it’s time for Democrats to start campaigning loudly and positively on the benefits of Obamacare?  Will you lead that charge?

And on Ukraine, you’ve said in other situations — Iran, for example — that the military option remains on the table even as talks go on.  Is the military option on the table with Russia?  And if so, would that be through NATO forces, through lethal aid to Ukraine?

THE PRESIDENT:  Now, keep in mind I think I’ve been very clear that military options are not on the table in Ukraine because this is not a situation that would be amenable to a clear military solution.  What we have to do is to create an environment in which irregular forces disarm, that the seizing of buildings cease, that a national dialogue by Ukrainians — not by Russians, not by Americans or anybody else, but by Ukrainians — takes place.  They move forward with reforms that meet the interests of the various groups within Ukraine, they move forward with elections, and they start getting their economic house in order.  That’s what’s going to solve the problem.

And so obviously, Russia right now still has its forces amassed along the Ukrainian-Russian border as a gesture of intimidation.  And it is our belief — and not ours alone — but I think broad portions of the international community believe that Russia’s hand is in the disruptions and chaos that we’ve been seeing in southern and eastern Ukraine.  But there is an opportunity for Russia to take a different approach.  We are encouraging them to do so.

In the meantime, we’re going to prepare additional responses should Russia fail to take a different course.  We’ve already had an impact on their economy that is well documented.  It could get significantly worse.  But we don’t have an interest in hurting ordinary Russians just for the sake of it.  Our strong preference would be for Mr. Putin to follow through on what is a glimmer of hope coming out of these Geneva talks.  But we’re not going to count on it until we see it.  And in the meantime, we’re going to prepare what our other options are.

With respect to the Affordable Care Act, my point is that we’ve been having a political fight about this for five years.  We need to move on to something else.  That’s what the American people are interested in.  I think that Democrats should forcefully defend and be proud of the fact that millions of people like the woman I just described who I saw in Pennsylvania yesterday we’re helping because of something we did.  I don’t think we should apologize for it, and I don’t think we should be defensive about it.  I think there is a strong, good, right story to tell.

I think what the other side is doing and what the other side is offering would strip away protections from those families and from hundreds of millions of people who already had health insurance before the law passed, but never knew if the insurance company could drop them when they actually needed it, or women who were getting charged more just because they were a woman.  I’m still puzzled why they’ve made this their sole agenda item when it comes to our politics.  It’s curious.

But what I intend to talk about is what the American people are interested in hearing:  Our plans for putting people back to work; our plans for making sure our economy continues to innovate; our plans to make sure that, as I discussed yesterday, we’re training people for the jobs that are out there right now and making better use of our community colleges and linking them up with businesses; and how we’re going to continue to bring manufacturing back the way we have over the last several years; and how we’re going to put more money in the pockets of ordinary people.

So if they want to — if Republicans want to spend all their time talking about repealing a law that’s working, that’s their business.  I think what Democrats should do is not be defensive, but we need to move on and focus on other things that are really important to the American people right now.

David Jackson.

Q    Yes, sir.  Thank you.  One reason the Republicans talk about it is there are people who object to the law who said they’ve had problems with the law, and there are a significant number of opponents of the law.  I guess my question is, what makes you think a significant majority of the American people, of voters, will accept this law?  Or are we destined to see health care as a 50/50, red state/blue state argument for years to come?

THE PRESIDENT:  I think you’re mixing up two things here, David.  You said there are people who have seen problems with the law.  That’s not 50 percent of the American people.  There may have been folks who have been affected in ways that they weren’t happy about — by the law.  That is a far smaller number than the millions of people who’ve been signed up.  That doesn’t mean we shouldn’t be concerned about it.  That’s an area where, as I said to Tamara, we should be open to other ways that we can make it even better.  So that’s objective facts and real problems out there.

The other side of it is just polling, right, what’s the general opinion of the law — which is attached to general opinions about me or about Democrats and partisanship in the country generally.

My view is that the longer we see the law benefiting millions of people, the more we see accusations that the law is hurting millions of people being completely debunked — as some of you in the press have done — and the more the average American who already has health insurance sees that it’s actually not affecting them in an adverse way, then it becomes less of a political football — which is where I want it to be.  This shouldn’t be a political football.  This should be something that we take for granted, that in this country you should be able to get affordable health care regardless of how wealthy you are.

Now, the larger issue about whether we can move past the polarization and sort of the bitter political debates between Democrats and Republicans, of which Obamacare is just one small part, that’s going to take more time.  But it’s not for lack of trying on my part.  And I think that I speak for all Democrats in saying we would much prefer a constructive conversation with the Republicans about how do we get some stuff done, and let’s focus on some areas that the American people really care about.

On jobs, we know that infrastructure would put people back to work right now and it would improve our economy for the long term.  It didn’t used to be a partisan issue.  Why aren’t we coming up with a way to make sure that we’re rebuilding our roads and our bridges, and improving our air traffic control system?  There’s no reason that has to be political.  There really isn’t any ideological disagreement on that.  And I guarantee you after this winter, if you look at the potholes that are the size of canyons all across big chunks of the United States, that people would like to see an infrastructure bill.  Let’s get it done.

Q    How long before health care ceases to become a political football, do you think?  Are we talking years?  Months?

THE PRESIDENT:  I think it’s hard to say.  It’s interesting, I spoke at the LBJ Library the other day, and most of us weren’t around to pay real close attention to those debates, or they’re pretty distant now in the past.  Apparently it took several years before people realized, hey, Medicare actually works and it’s lifting a lot of seniors out of despair and poverty.

So we’ve been through this cycle before.  It happens each and every time we make some strides in terms of strengthening our commitments to each other and we expand some of these social insurance programs.

There’s a lot of fear-mongering and a lot of political argument and debate, and a lot of accusations are flung back and forth about socialized medicine and the end of freedom.  And then it turns out that, you know what, it’s working for a lot of folks, and we still live in a free-market society and the Constitution is intact.  And then we move on.  And I don’t know how long it’s going to take.  But in the meantime, how about us focusing on some things that the American people really care about?

Thank you, everybody.

END
4:13 P.M. EDT

 

Political Musings April 2, 2014: Obama vindicated 7.1 million sign-up for Obamacare reaching White House goal

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Obama vindicated 7.1 million sign-up for Obamacare reaching White House goal

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A day after the open enrollment period ended to sign-up for health care insurance, President Barack Obama announced on Tuesday, April 1, 2014 at a ceremony held in the White House Rose Garden that the Affordable Care Act reached…READ MORE

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Political Musings November 14, 2013: Obama offers health care fix for Americans with cancelled policies is it enough?

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Full Text Obama Presidency November 14, 2013: President Barack Obama’s Press Conference Announcing Fix for Americans Receiving Health Insurance Cancellation

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OBAMA PRESIDENCY & THE 113TH CONGRESS:

President Obama Announces New Steps to Help Americans Receiving Insurance Cancellation Notices

Source: WH, 11-14-13 

President Barack Obama answers questions at a news conference in the James S. Brady Press Briefing Room of the White HousePresident Barack Obama answers questions at a news conference in the James S. Brady Press Briefing Room of the White House, Nov. 14, 2013. (Official White House Photo by Pete Souza)

Statement by the President on the Affordable Care Act

Source: WH, 11-14-13

James S. Brady Press Briefing Room

12:02 P.M. EST

THE PRESIDENT:  Today I want to update the American people on our efforts to implement and improve the Affordable Care Act, and I’ll take a couple of your questions.  But before I do, I just want to say a few words about the tragedy that’s unfolded in the Philippines.

Over the past few days, I think all of us have been shaken by the images of the devastation wrought by Typhoon Haiyan.  It’s a heartbreaking reminder of how fragile life is, and among the dead are several Americans.  So our prayers are with the Filipino people, and with Filipino Americans across our country who are anxious about their family and friends back home.

One of our core principles is, when friends are in trouble, America helps.  As I told President Aquino earlier this week, the United States will continue to offer whatever assistance we can.  Our military personnel and USAID team do this better than anybody in the world, and they’ve been already on the ground working tirelessly to deliver food, water, medicine, shelter, and to help with airlift.  Today, the aircraft carrier USS George Washington and other ships arrived to help with search- and-rescue, as well as supplies, medical care and logistical support.  And more help is on the way.

America’s strength, of course, has always been more than just about what our government can do –- it’s also about what our citizens can do.  It’s about the big-heartedness of the American people when they see other folks in trouble.  So today, I would encourage everybody who wants to help, to visit WhiteHouse.gov/typhoon — that’s WhiteHouse.gov/typhoon — and that will offer you links to organizations that are working on the ground and ways that you can support their efforts.  Our friends in the Philippines will face a long, hard road ahead, but they’ll continue to have a friend and partner in the United States of America.

Now, switching gears, it has now been six weeks since the Affordable Care Act’s new marketplace has opened for business.  I think it’s fair to say that the rollout has been rough so far.  And I think everybody understands that I’m not happy about the fact that the rollout has been wrought with a whole range of problems that I’ve been deeply concerned about.  But today I want to talk about what we know after these first few weeks and what we’re doing to implement and improve the law.

Yesterday, the White House announced that in the first month, more than 100,000 Americans successfully enrolled in new insurance plans.  Is that as high a number as we’d like?  Absolutely not.  But it does mean that people want affordable health care.  The problems of the website have prevented too many Americans from completing the enrollment process.  And that’s on us, not on them.  But there is no question that there’s real demand for quality, affordable health insurance.

In the first month, nearly a million people successfully completed an application for themselves or their families.  Those applications represent more than 1.5 million people.  Of those 1.5 million people, 106,000 of them have successfully signed up to get covered.

Another 396,000 have the ability to gain access to Medicaid under the Affordable Care Act.  That’s been less reported on, but it shouldn’t be.  Americans who are having a difficult time, who are poor, many of them working, may have a disability; they’re Americans like everybody else, and the fact that they are now able to get insurance is going to be critically important.

Later today, I’ll be in Ohio, where Governor Kasich, a Republican, has expanded Medicaid under the Affordable Care Act.  And as many as 275,000 Ohioans will ultimately be better off because of it.  And if every governor followed suit, another 5.4 million Americans could gain access to health care next year.

So bottom line is, in just one month, despite all the problems that we’ve seen with the website, more than 500,000 Americans could know the security of health care by January 1st — many of them for the first time in their lives.  And that’s life-changing and it’s significant.

That still leaves about 1 million Americans who successfully made it through the website, and now qualify to buy insurance, but haven’t picked a plan yet.  And there’s no question that if the website were working as it’s supposed to, that number would be much higher of people who have actually enrolled.  So that’s problem number one –- making sure that the website works the way it’s supposed to.  It’s gotten a lot better over the last few weeks than it was on the first day, but we’re working 24/7 to get it working for the vast majority of Americans in a smooth, consistent way.

The other problem that has received a lot of attention
concerns Americans who have received letters from their insurers that they may be losing the plans they bought in the old individual market, often because they no longer meet the law’s requirements to cover basic benefits like prescription drugs or doctors’ visits.

Now, as I indicated earlier, I completely get how upsetting this can be for a lot of Americans, particularly after assurances they heard from me that if they had a plan that they liked, they could keep it.  And to those Americans, I hear you loud and clear.  I said that I would do everything we can to fix this problem.  And today I’m offering an idea that will help do it.

Already, people who have plans that predate the Affordable Care Act can keep those plans if they haven’t changed.  That was already in the law.  That’s what’s called a grandfather clause.  It was included in the law.  Today, we’re going to extend that principle both to people whose plans have changed since the law took effect, and to people who bought plans since the law took effect.

So state insurance commissioners still have the power to decide what plans can and can’t be sold in their states.  But the bottom line is, insurers can extend current plans that would otherwise be canceled into 2014, and Americans whose plans have been canceled can choose to re-enroll in the same kind of plan.

We’re also requiring insurers to extend current plans to inform their customers about two things.  One, that protections — what protections these renewed plans don’t include.  And number two, that the marketplace offers new options with better coverage and tax credits that might help you bring down the cost.

So if you’ve received one of these letters, I’d encourage you to take a look at the marketplace.  Even if the website isn’t working as smoothly as it should be for everybody yet, the plan comparison tool that lets you browse costs for new plans near you is working just fine.

Now, this fix won’t solve every problem for every person.  But it’s going to help a lot of people.  Doing more will require work with Congress.  And I’ve said from the beginning, I’m willing to work with Democrats and Republicans to fix problems as they arise.  This is an example of what I was talking about.  We can always make this law work better.

It is important to understand, though, that the old individual market was not working well.  And it’s important that we don’t pretend that somehow that’s a place worth going back to.  Too often, it works fine as long as you stay healthy; it doesn’t work well when you’re sick.  So year after year, Americans were routinely exposed to financial ruin, or denied coverage due to minor preexisting conditions, or dropped from coverage altogether — even if they paid their premiums on time.

That’s one of the reasons we pursued this reform in the first place.  And that’s why I will not accept proposals that are just another brazen attempt to undermine or repeal the overall law and drag us back into a broken system.  We will continue to make the case, even to folks who choose to keep their own plans, that they should shop around in the new marketplace because there’s a good chance that they’ll be able to buy better insurance at lower cost.

So we’re going to do everything we can to help the Americans who have received these cancellation notices.  But I also want everybody to remember there are still 40 million Americans who don’t have health insurance at all.  I’m not going to walk away from 40 million people who have the chance to get health insurance for the first time.  And I’m not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years.

So we’re at the opening weeks of the project to build a better health care system for everybody — a system that will offer real financial security and peace of mind to millions of Americans.  It is a complex process.  There are all kinds of challenges.  I’m sure there will be additional challenges that come up.  And it’s important that we’re honest and straightforward in terms of when we come up with a problem with these reforms and these laws, that we address them.  But we’ve got to move forward on this.

It took 100 years for us to even get to the point where we could start talking about and implementing a law to make sure everybody has got health insurance.  And my pledge to the American people is, is that we’re going to solve the problems that are there, we’re going to get it right, and the Affordable Care Act is going to work for the American people.

So with that, I’m going to take your questions, and I’m going to start with Julie Pace of AP.

Q    Thank you, Mr. President.  The combination of the website problems and the concerns over the policy cancellations has sparked a lot of worry within your own party, and polls also show that you’re taking some hits with the public on both your overall job approval rating and also on factors like trust and honesty.  Do you feel as though the flawed health care rollout has led to a breach in the public trust and confidence in government?  And if so, how do you plan to resolve that?

THE PRESIDENT:  There is no doubt that people are frustrated.  We just came out of a shutdown and the possibility that for the first time in over 200 years, we wouldn’t pay our bills.  And people breathed a sigh of relief when that finally got done, and the next thing they know is, is that the President’s health care reform can’t get the website to work and that there are these other problems with respect to cancellation notices.

And I understand why folks are frustrated.  I would be, too.  Because sometimes people look at what’s taking place in Washington and they say, not enough is getting done that helps me with my life.  And regardless of what Congress does, ultimately I’m the President of the United States and they expect me to do something about it.

So in terms of how I intend to approach it, I’m just going to keep on working as hard as I can around the priorities that the American people care about.  And I think it’s legitimate for them to expect me to have to win back some credibility on this health care law in particular, and on a whole range of these issues in general.

And that’s on me.  I mean, we fumbled the rollout on this health care law.  There are a whole bunch of things about it that are working really well which people didn’t notice because they weren’t controversial — so making sure kids could stay on their parents’ plans until they were — through the age of 25, and making sure that seniors got more discounts on their prescription drugs.  There were a whole bunch of stuff that we did well over the first three years.

But we always knew that these marketplaces, creating a place where people can shop and through competition get a better deal for the health insurance that their families need, we always knew that that was going to be complicated and everybody was going to be paying a lot of attention to it.  And we should have done a better job getting that right on day one — not on day 28 or on day 40.

I am confident that by the time we look back on this next year, that people are going to say this is working well, and it’s helping a lot of people.  But my intention in terms of winning back the confidence of the American people is just to work as hard as I can; identify the problems that we’ve got, make sure that we’re fixing them.  Whether it’s a website, whether it is making sure that folks who got these cancellation notices get help, we’re just going to keep on chipping away at this until the job is done.

Major Garrett.

Q    Thank you, Mr. President.  You said while the law was being debated, “if you like your plan, you can keep it.”  You said after the law was implemented or signed, “if you like your plan, you can keep it.”  Americans believed you, sir, when you said that to them over and over.  Do you not believe, sir, the American people deserve a deeper, more transparent accountability from you as to why you said that over and over when your own statistic published in the Federal Register alerted your policy staff — and I presume you — to the fact that millions of Americans would, in fact, probably fall into the very gap you’re trying to administratively fix now?

That’s one question.  Second question.  (Laughter.)  You were informed, or several people in this building were informed two weeks before the launch of the website that it was failing the most basic tests internally, and yet a decision was made to launch the website on October 1st.  Did you, sir, make that test?  And if so, did you regret that?

THE PRESIDENT:  Okay, on the website, I was not informed directly that the website would not be working the way it was supposed to.  Had I been informed, I wouldn’t be going out saying, boy, this is going to be great.

I’m accused of a lot of things, but I don’t think I’m stupid enough to go around saying, this is going to be like shopping on Amazon or Travelocity a week before the website opens if I thought that it wasn’t going to work.  So clearly, we and I did not have enough awareness about the problems in the website.  Even a week into it, the thinking was that these were some glitches that would be fixed with patches, as opposed to some broader systemic problems that took much longer to fix and we’re still working on them.

So that doesn’t excuse the fact that they just don’t work.  But I think it’s fair to say that, no, Garrett — Major, we would not have rolled out something knowing very well that it wasn’t going to work the way it was supposed, given all the scrutiny that we knew was going to be on the website.

With respect to the pledge I made that if you like your plan, you can keep it, I think — and I’ve said in interviews — that there is no doubt that the way I put that forward unequivocally ended up not being accurate.  It was not because of my intention not to deliver on that commitment and that promise.  We put a grandfather clause into the law, but it was insufficient.

Keep in mind that the individual market accounts for 5 percent of the population.  So when I said you can keep your health care, I’m looking at folks who’ve got employer-based health care; I’m looking at folks who’ve got Medicare and Medicaid — and that accounts for the vast majority of Americans.  And then for people who don’t have any health insurance at all, obviously that didn’t apply.  My commitment to them was, you’re going to be able to get affordable health care for the first time.

You have an individual market that accounts for about 5 percent of the population.  And our working assumption was — my working assumption was that the majority of those folks would find better policies at lower costs or the same costs in the marketplaces, and that the universe of folks who potentially would not find a better deal in the marketplaces, the grandfather clause would work sufficiently for them.  And it didn’t.  And again, that’s on us.  Which is why we’re — that’s on me.  And that’s why I’m trying to fix it.

And as I said earlier, I guess last week, and I will repeat, that’s something I deeply regret because it’s scary getting a cancellation notice.

Now, it is important to understand that out of that population, typically there is constant churn in that market.  This market is not very stable and reliable for people.  So people have a lot of complaints when they’re in that marketplace.  As long as you’re healthy, things seem to be going pretty good.  And so a lot of people think, I’ve got pretty good insurance — until they get sick — and then suddenly they look at the fine print, and they’ve got a $50,000 out-of-pocket expense that they can’t pay.

We know that on average over the last decade, each year, premiums in that individual market would go up an average of 15 percent a year.  I know that because when we were talking about health care reform, one of the complaints was:  I bought health care in the individual market and I just got a notice from the insurer, they dropped me after I had an illness; or my premium skyrocketed by 20 or 30 percent, why aren’t we doing something about this?

So part of what our goal has been is to make sure that that individual market is stable and fair, and has the kind of consumer protections that make sure that people don’t get a rude surprise when they really need health insurance.  But if you just got a cancellation notice, and so far you’re thinking, my prices are pretty good, you haven’t been sick, and it fits your budget, and now you get this notice — you’re going to be worried about it.  And if the insurer is saying the reason you’re getting this notice is because of the Affordable Care Act, then you’re going to be understandably aggravated about it.

Now, for a big portion of those people, the truth is they might have gotten a notice saying, we’re jacking up your rates by 30 percent.  They might have said, from here on out, we’re not going to cover X, Y and Z illnesses, we’re changing the — because these were all 12-month policies.  The insurance companies were under no obligation to renew the exact same policies that you had before.

But, look, one of the things I understood when we decided to reform that health insurance market, part of the reason why it hasn’t been done before and it’s very difficult to do, is that anything that’s going on that’s tough in the health care market, if you initiated a reform, can be attributed to your law.  And so what we want to do is to be able to say to these folks, you know what, the Affordable Care Act is not going to be the reason why insurers have to cancel your plan.

Now, what folks may find is the insurance companies may still come back and say, we want to charge you 20 percent more than we did last year; or we’re not going to cover prescription drugs now.  But that’s in the nature of the market that existed earlier.

Q    Did you decide, sir, that the simple declaration was something the American people could handle, but this nuanced answer you just gave now was something that you couldn’t handle and you didn’t trust the American people with a fuller truth?

THE PRESIDENT:  No.  I think, as I said earlier, Major, my expectation was that for 98 percent of the American people, either it genuinely wouldn’t change at all, or they’d be pleasantly surprised with the options in the marketplace, and that the grandfather clause would cover the rest.

That proved not to be the case.  And that’s on me.  And the American people — those who got cancellation notices do deserve and have received an apology from me.  But they don’t want just words.  What they want is whether we can make sure that they are in a better place, and that we meet that commitment.

And, by the way, I think it’s very important for me to note that there are a whole bunch of folks up in Congress and others who made this statement, and they were entirely sincere about it.  And the fact that you’ve got this percentage of people who have had this impact — I want them to know that their senator or congressman, they were making representations based on what I told them and what this White House and our administrative staff told them.  And so it’s not on them.  It’s on us.  But it is something that we intend to fix.

Steve Collinson.

Q    Do you have reason to believe that Iran would walk away from nuclear talks if Congress draws up new sanctions?  And would a diplomatic breakdown at this stage leave you no option but military action?  And how do you respond to your critics on the Hill who say that it was only tough sanctions that got Iran to the table, but only tougher sanctions will make it capitulate?

THE PRESIDENT:  Well, let me make a couple of points.  Number one, I’ve said before and I will repeat:  We do not want Iran having nuclear weapons.  And it would be not only dangerous to us and our allies, but it would be destabilizing to the entire region, and could trigger a nuclear arms race that would make life much more dangerous for all of us.  So our policy is Iran cannot have nuclear weapons.  And I’m leaving all options on the table to make sure that we meet that goal.

Point number two:  The reason we’ve got such vigorous sanctions is because I and my administration put in place, when I came into office, the international structure to have the most effective sanctions ever.  And so I think it’s fair to say that I know a little bit about sanctions, since we’ve set them up, and made sure that we mobilize the entire international community so that there weren’t a lot of loopholes and they really had bite.

And the intention in setting up those sanctions always was to bring the Iranians to the table so that we could resolve this issue peacefully, because that is my preference.  That’s my preference because any armed conflict has cost to it, but it’s also my preference because the best way to assure that a country does not have nuclear weapons is that they are making a decision not to have nuclear weapons, and we’re in a position to verify that they don’t have nuclear weapons.

So as a consequence of the sanctions that we put in place  — and I appreciate all the help, bipartisan help, that we received from Congress in making that happen — Iran’s economy has been crippled.  They had a -5 percent growth rate last year.  Their currency plummeted.  They’re having significant problems in just the day-to-day economy on the ground in Iran.  And President Rouhani made a decision that he was prepared to come and have a conversation with the international community about what they could do to solve this problem with us.

We’ve now had a series of conversations, and it has never been realistic that we would resolve the entire problem all at once.  What we have done is seen the possibility of an agreement in which Iran would halt advances on its program; that it would dilute some of the highly enriched uranium that makes it easier for them to potentially produce a weapon; that they are subjecting themselves to much more vigorous inspections so that we know exactly what they’re doing at all their various facilities; and that that would then provide time and space for us to test, over a certain period of months, whether or not they are prepared to actually resolve this issue to the satisfaction of the international community — making us confident that, in fact, they’re not pursuing a nuclear weapons program.

In return, the basic structure of what’s been talked about, although not completed, is that we would provide very modest relief at the margins of the sanctions that we’ve set up.  But importantly, we would leave in place the core sanctions that are most effective and have most impact on the Iranian economy, specifically oil sanctions and sanctions with respect to banks and financing.  And what that gives us is the opportunity to test how serious are they, but it also gives us an assurance that if it turns out six months from now that they’re not serious, we can crank — we can dial those sanctions right back up.

So my message to Congress has been that, let’s see if this short-term, phase-one deal can be completed to our satisfaction where we’re absolutely certain that while we’re talking with the Iranians, they’re not busy advancing their program.  We can buy some additional months in terms of their breakout capacity.  Let’s test how willing they are to actually resolve this diplomatically and peacefully.

We will have lost nothing if, at the end of the day, it turns out that they are not prepared to provide the international community the hard proof and assurances necessary for us to know that they’re not pursuing a nuclear weapon.  And if that turns out to be the case, then not only is our entire sanctions infrastructure still in place, not only are they still losing money from the fact that they can’t sell their oil and get revenue from their oil as easily, even throughout these talks, but other options remain.

But what I’ve said to members of Congress is that if, in fact, we’re serious about trying to resolve this diplomatically — because no matter how good our military is, military options are always messy, they’re always difficult, always have unintended consequences, and in this situation are never complete in terms of making us certain that they don’t then go out and pursue even more vigorously nuclear weapons in the future — if we’re serious about pursuing diplomacy, then there’s no need for us to add new sanctions on top of the sanctions that are already very effective and that brought them to the table in the first place.

Now, if it turns out they can’t deliver, they can’t come to the table in a serious way and get this issue resolved, the sanctions can be ramped back up.  And we’ve got that option.

All right.  Roger Runningen.  Roger, it’s his birthday, by the way.  So that’s not the reason you got a question, but I thought it was important to note that.

Q    Thank you, Mr. President.

THE PRESIDENT:  Happy birthday.

Q    Back to health care.  Can you guarantee for the American people that the health care website is going to be fully operational for all people, not just the vast majority, by November 30?  And second, more broadly, this is your signature domestic piece of legislation.  You hear criticism on the Hill that you and your White House team are too insular.  Is that how this mess came to be?

THE PRESIDENT:  Well, I think there is going to be a lot of evaluation of how we got to this point.  And I assure you that I’ve been asking a lot of questions about that.  The truth is that this is, number one, very complicated.  The website itself is doing a lot of stuff.  There aren’t a lot of websites out there that have to help people compare their possible insurance options, verify income to find out what kind of tax credits they might get, communicate with those insurance companies so they can purchase, make sure that all of it’s verified.  So there’s just a bunch of pieces to it that made it challenging.

And you combine that with the fact that the federal government does a lot of things really well.  One of the things it does not do well is information technology procurement.  This is kind of a systematic problem that we have across the board.  And it is not surprising then that there were going to be some problems.

Now, I think we have to ask ourselves some hard questions inside the White House as opposed to why we didn’t see more of these problems coming earlier on — A, so we could set expectations; B, so that we could look for different ways for people to end up applying.

So ultimately, you’re right.  This is something that’s really important to me, and it’s really important to millions of Americans who have been waiting for a really long time to try to get health care because they don’t have it.  And I am very frustrated, but I’m also somebody who, if I fumbled the ball, I’m going to wait until I get the next play, and then I’m going to try to run as hard as I can and do right by the team.  So ultimately, I’m the head of this team.  We did fumble the ball on it, and what I’m going to do is make sure that we get it fixed.

In terms of what happens on November 30th or December 1st, I think it’s fair to say that the improvement will be marked and noticeable.  The website will work much better on November 30th, December 1st than it worked certainly on October 1st.  That’s a pretty low bar.  It will be working a lot better than it is — it was last week, and it will be working better than it was this week, which means that the majority of people who go to the website will see a website that is working the way it’s supposed to.

I think it is not possible for me to guarantee that 100 percent of the people 100 percent of the time going on this website will have a perfectly seamless, smooth experience.  We’re going to have to continue to improve it even after November 30th, December 1st.  But the majority of people who use it will be able to see it operate the way it was supposed to.

One thing that we’ve discovered, though, that I think is worth noting:  A lot of focus has been on the website and the technology, and that’s partly because that’s how we initially identified it — these are glitches.  What we’re discovering is that part of the problem has been technology — hardware and software — and that’s being upgraded.  But even if we get the hardware and software working exactly the way it’s supposed to with relatively minor glitches, what we’re also discovering is that insurance is complicated to buy.

And another mistake that we made I think was underestimating the difficulties of people purchasing insurance online and shopping for a lot of options with a lot of costs and a lot of different benefits and plans, and somehow expecting that that would be very smooth.  And then they’ve also got to try apply for tax credits on the website.

So what we’re doing even as we’re trying to solve the technical problems is also what can we do to make the application a little bit simpler; what can we do to make it in English as opposed to bureaucratese; are there steps that we can skip while still getting the core information that people need

And part of what we’re realizing is that they are going to be a certain portion of people who are just going to need more help and more handholding in the application process.  And so I guess part of the continuous improvement that I’m looking at is not just a technical issue.  It’s also, can we streamline the application process; what are we doing to give people more assistance in the application process; how do the call centers and the people who are helping folks in-person; how are they trained so that things can go more smoothly.

Because the bottom line ultimately is, I just want people to know what their options are in a clear way.  And buying health insurance is never going to be like buying a song on iTunes.  It’s just a much more complicated transaction.  But I think we can continue to make it better — all of which is to say that on December 1st, November 30th, it will be a lot better, but there will still be some problems.  Some of those will not be because of technological problems — although I’m sure that there will still be some glitches that have to be smoothed out.  Some of it’s going to be how are we making this application process more user-friendly for folks.

And one good example of this, by the way, just to use an analogy — when we came into office, we heard a lot of complaints about the financial aid forms that families have to fill out to get federal financial aid.  And I actually remember applying for some of that stuff and remember how difficult and confusing it was.  And Arne Duncan over at Education worked with a team to see what we could do to simplify it, and it made a big difference.

And that’s part of the process that we’ve got to go through.  And in fact, if we can get some focus groups and we sit down with actual users and see how well is this working, what would improve it, what part of it didn’t you understand —  that all I think is part of what we’re going to be working on in the weeks ahead.

Q    What about the insularity criticism that you hear on the Hill?

THE PRESIDENT:  I’ve got to say I meet with an awful lot of folks, and I talk to an awful lot of folks every day.  And I have lunches with CEOs and IT venture capitalists and labor leaders and pretty much folks from all walks of life on a whole bunch of topics.  And if you looked at my schedule on any given day, we’re interacting with a whole lot of people.

And I think it’s fair to say that we have a pretty good track record of working with folks on technology and IT from our campaign where, both in 2008 and 2012, we did a pretty darn good job on that.  So it’s not — the idea that somehow we didn’t have access or were interested in people’s ideas, I think isn’t accurate.  What is true is that, as I said before, our IT systems, how we purchase technology in the federal government is cumbersome, complicated, and outdated.

And so this isn’t a situation where on my campaign I could simply say, who are the best folks out there; let’s get them around a table, let’s figure out what we’re doing, and we’re just going to continue to improve it and refine it and work on our goals.  If you’re doing it at the federal government level, you’re going through 40 pages of specs and this and that and the other, and there are all kinds of laws involved, and it makes it more difficult.  It’s part of the reason why, chronically, federal IT programs are over budget, behind schedule.

And one of the — when I do some Monday morning quarterbacking on myself, one of the things that I do recognize is — since I know that the federal government has not been good at this stuff in the past — two years ago, as we were thinking about this, we might have done more to make sure that we were breaking the mold on how we were going to be setting this up.  But that doesn’t help us now.  We’ve got to move forward.

Jeff Mason.

Q    Thank you, Mr. President.  Today’s fix that you just announced leaves it up to state insurance commissioners and insurance companies to ultimately decide whether to allow old policies to be renewed for a year.  How confident are you that they will do that?  And secondly, how concerned are you that this flawed rollout may hurt Democrats’ chances in next year’s midterm elections, and your ability to advance other priorities such as immigration reform?

THE PRESIDENT:  On the first question, traditionally, state insurance commissioners make decisions about what plans can be or cannot be sold, how they interact with insurers.  What we’re essentially saying is the Affordable Care Act is not going to be the factor in what happens with folks in the individual market.  And my guess is right away you’re going to see a number of state insurance commissioners exercise it.

Part of the challenge is the individual markets are different in different states.  There are some states that have individual insurance markets that already have almost all the consumer protections that the Affordable Care Act does.  They match up pretty good.  It’s not some big jump for folks to move into the marketplace.  In others, they’re pretty low standards, so you can sell pretty substandard plans in those markets.  And that’s where people might see a bigger jump in their premiums.

So I think there’s going to be some state-by-state evaluation on how this is handled.  But the key point is, is that it allows us to be able to say to the folks who received these notices:  Look, I, the President of the United States and the insurance –- that the insurance model, the Affordable Care Act, is not going to be getting in the way of you shopping in the individual market that you used to have.  As I said, there are still going to be some folks who over time, I think, are going to find that the marketplaces are better.

One way I described this to — I met with a group of senators when this issue first came up — and it’s not a perfect analogy — but we made a decision as a society that every car has to have a seatbelt or airbags.  And so you pass a regulation.  And there are some additional costs, particularly at the start of increasing the safety and protections, but we make a decision as a society that the costs are outweighed by the benefits of all the lives that are saved.  So what we’re saying now is if you’re buying a new car, you got to have a seatbelt.

Well, the problem with the grandfather clause that we put in place is it’s almost like we said to folks, you got to buy a new car, even if you can’t afford it right now.  And sooner or later, folks are going to start trading in their old cars.  But we don’t need — if their life circumstance is such where, for now at least, they want to keep the old car, even if the new car is better, we should be able to give them that option.  And that’s what we want to do.

And, by the way, that’s what we should have been able to do in drafting the rules in the first place.  So, again, these are two fumbles on something that — on a big game, which — but the game is not over.

With respect to the politics of it, I’ll let you guys do a lot of the work on projecting what this means for various political scenarios.  There is no doubt that our failure to roll out the ACA smoothly has put a burden on Democrats, whether they’re running or not, because they stood up and supported this effort through thick and thin.  And I feel deeply responsible for making it harder for them rather than easier for them to continue to promote the core values that I think led them to support this thing in the first place — which is, in this country, as wealthy as we are, everybody should be able to have the security of affordable health care.  And that’s why I feel so strongly about fixing it.

My first and foremost obligation is the American people, to make sure that they can get what’s there — if we can just get the darn website working and smooth this thing out — which is plans that are affordable, and allow them to take advantage of tax credits and give them a better deal.

But I also do feel an obligation to everybody out there who supported this effort.  When we don’t do a good job on the rollout, we’re letting them down.  And I don’t like doing that.  So my commitment to them is, we’re going to just keep on doing better every day until we get it done.

And in terms of the impact on me — I think to some extent I addressed it when I talked to Julie — there are going to be ups and downs during the course of my presidency.  And I think I said early on when I was running — I am not a perfect man, and I will not be a perfect President, but I’ll wake up every single day working as hard as I can on behalf of Americans out there from every walk of life who are working hard, meeting their responsibilities, but sometimes are struggling because the way the system works isn’t giving them a fair shot.

And that pledge I haven’t broke.  That commitment, that promise, continues to be — continues to hold — the promise that I wouldn’t be perfect, number one, but also the promise that as long as I’ve got the honor of having this office, I’m just going to work as hard as I can to make things better for folks.  And what that means specifically in this health care arena is we can’t go back to the status quo.

I mean, right now everybody is properly focused on us not doing a good job on the rollout, and that’s legitimate and I get it.  There have been times where I thought we were kind of slapped around a little bit unjustly.  This one is deserved.  Right?  It’s on us.

But we can’t lose sight of the fact that the status quo before the Affordable Care Act was not working at all.  If the health care system had been working fine, and everybody had high-quality health insurance at affordable prices, I wouldn’t have made it a priority; we wouldn’t have been fighting this hard to get it done — which is why, when I see sometimes folks up on Capitol Hill, and Republicans in particular, who have been suggesting repeal, repeal, let’s get rid of this thing, I keep on asking what is it that you want to do?  Are you suggesting that the status quo was working?  Because it wasn’t, and everybody knows it.  It wasn’t working in the individual market and it certainly wasn’t working for the 41 million people who didn’t have health insurance.

And so what we did was we chose a path that was the least disruptive, to try to finally make sure that health care is treated in this country like it is in every other advanced country — that it’s not some privilege that just a certain portion of people can have, but it’s something that everybody has some confidence about.  And we didn’t go far left and choose an approach that would have been much more disruptive.  We didn’t adopt some more conservative proposals that would have been much more disruptive.  We tried to choose a way that built off the existing system.  But it is complicated, it is hard, but I make no apologies for us taking this on — because somebody sooner or later had to do it.  I do make apologies for not having executed better over the last several months.

Q    And do you think that execution and the flaws in the rollout will affect your ability to do other things, like immigration reform and other policy priorities?

THE PRESIDENT:  Well, look, if it comes to immigration reform, there is no reason for us not to do immigration reform.  And we’ve already got strong bipartisan support for immigration reform out of the Senate.  You’ve got — I met with a number of traditionally very conservative clergy who are deeply committed to immigration reform.  We’ve got the business community entirely behind immigration reform.  So you’ve got a bunch of constituencies that are traditionally much more — have leaned much more heavily towards the Republicans who are behind this.

So if people are looking for an excuse not to do the right thing on immigration reform, they can always find an excuse —  we’ve run out of time, or this is hard, or the list goes on and on.  But my working assumption is people should want to do the right thing.  And when you’ve got an issue that would strengthen borders, make sure that the legal immigration system works the way it’s supposed to, that would go after employers who have been doing the wrong thing when it comes to hiring undocumented workers, and would allow folks who are here illegally to get right with the law and pay a fine, and learn English and get to the back of the line, but ultimately join fully our American community — when you’ve got a law that makes sense, you shouldn’t be looking for an excuse not to do it.  And I’m going to keep on pushing to make sure it gets done.

Am I going to have to do some work to rebuild confidence around some of our initiatives?  Yes.  But part of this job is the things that go right, you guys aren’t going to write about; the things that go wrong get prominent attention.  That’s how it has always been.  That’s not unique to me as President.  And I’m up to the challenge.  We’re going to get this done.

All right?  Thank you, everybody.

END
12:53 P.M. EST

Political Musings November 13, 2013: Former President Bill Clinton joins circle critical of Obamacare

POLITICAL MUSINGS

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OBAMA PRESIDENCY & THE 113TH CONGRESS:

OP-EDS & ARTICLES

Former President Bill Clinton joins circle critical of Obamacare

By Bonnie K. Goodman

President Barack Obama’s circle of critics regarding his health care law, the Affordable Care Act is widening. On Tuesday, Nov. 12, 2013 former President Bill Clinton called on Obama to change a key element of his law to…READ MORE

Political Musings November 10, 2013: Obama finally apologizes after spending week defending embattled health care law

POLITICAL MUSINGS

https://historymusings.files.wordpress.com/2013/06/pol_musings.jpg?w=600

OBAMA PRESIDENCY & THE 113TH CONGRESS:

OP-EDS & ARTICLES

Obama finally apologizes after spending week defending embattled health care law

By Bonnie K. Goodman

President Barack Obama spent all this past week defending his health care law, the Affordable Care Act only to admit in an NBC News interview on Thursday, Nov. 7, 2013 that he was wrong about one his major promises with…READ MORE

Full Text Obama Presidency October 30, 2013: President Barack Obama’s Speech on the Health Care Law, on the Affordable Care Act at Faneuil Hall, Boston

POLITICAL TRANSCRIPTS

OBAMA PRESIDENCY & THE 113TH CONGRESS:

Remarks by the President and Governor Deval Patrick on the Affordable Care Act

Source: WH, 10-30-13

 

U.S. President Barack Obama

Jewel Samad/AFP/Getty Images

U.S. President Barack Obama speaks on healthcare at Faneuil Hall in Boston on Oct. 30, 2013.

Faneuil Hall
Boston, Massachusetts

3:50 P.M. EDT

GOVERNOR PATRICK:  How are you?  Good afternoon, everybody.  (Applause.)  How’s Red Sox Nation this afternoon?  (Applause.)

Ladies and gentlemen, brothers and sisters, fellow citizens, I have the high honor of introducing to you the President of the United States.  (Applause.)  But, of course, you folks already know him.  (Laughter.)  So as the President is standing just offstage, I want to take my time here at the podium — (laughter) — to introduce all of you to him.

In this storied hall today, Mr. President, are the architects and advocates for health care reform in Massachusetts. (Applause.)  This gathering right here is the broad coalition — providers, payers, patients, consumers, policymakers, academics, business and labor, from both political parties, or no party at all — who came together to invent health care reform in Massachusetts and then, importantly, stuck together to refine it as we moved forward.  (Applause.)

You are the leaders who, when we learned a hard lesson or hit a wall, stuck with it and with each other because of the shared value that health care is a public good and that every citizen deserves access to quality, affordable care.  (Applause.)

Quality, affordable care accessible to all improves lives, and in many cases, saves lives.  It gives peace of mind and economic security to working families.  It increases productivity for large and small employers alike.  It creates jobs and contributes to the strength of the Massachusetts economy.  It is a powerful statement of who we are as a commonwealth.  (Applause.)

And by every reasonable measure, it has been a success for us here in the Commonwealth of Massachusetts.  (Applause.)  How do we know?  Virtually, every resident in the commonwealth is insured today.  (Applause.)  More private companies offer insurance to their employees than ever before.  Over 90 percent of our residents have a primary care physician.  Preventive care is up and health disparities are down.  (Applause.)  Most important of all, on a whole range of measures, we are healthier both physically and mentally.

Over all these years, expansion itself has added only about 1 percent of state spending to our budget.  And thanks to the collective, continued hard work of this coalition, premiums are finally easing up.  Premium base rates were increasing over 16 percent just a few years ago.  Today, increases average less than 2 percent.  (Applause.)

And thanks to the President, America can look forward to the successes that Massachusetts has experienced these last seven years.  (Applause.)

The truth is policy only matters when and where it touches people.  I know this policy matters because I’ve met people all across the commonwealth, in every walk of life, whose lives have been improved or saved because of the care our reforms made possible.  A couple of them are here today.

Laura Ferreira — where are you, Laura?  There you are.  Owns her own hair salon and is responsible for providing health insurance to her family of five, including her son, Mason, who’s right here with her.  Mason has a rare genetic condition.  Laura is able to afford his medicine because they found coverage through our Connecter, our version of the ACA marketplace.  This policy matters.  (Applause.)

David Gilloran works as a waiter.  Where are you David?  There you are.  Thank you for being here.  Soon after getting coverage through the Connector, David was diagnosed with Hodgkin’s lymphoma.  His treatment was covered, and he is back to his old life and swimming for exercise.  God bless you, David.  (Applause.)

Brian Thurber left his law firm job to become an entrepreneur in Massachusetts.  Brian, where are you?  There he is.  Because he was able to access quality insurance directly through the Connector, he is chasing his entrepreneurial dreams and on his way to becoming a creator of jobs for others without  — being exposed to a health emergency along the way.  Keep going.  Good luck to you.  (Applause.)

Hundreds of thousands of Massachusetts people don’t fear going bankrupt from medical bills, or being thrown off their insurance if they get really sick, or being declared ineligible for insurance because they were seriously ill sometime in the past.

If policy matters where it touches people, Mr. President, this policy matters a lot.  Health care reform is working for the people of Massachusetts, and it will work for the people of America.  (Applause.)

My Republican predecessor signed the legislation to expand health care reform in Massachusetts right here in this room, on this very stage.  His chief legislative partner was the Democratic state senator, Robert Travaglini, who was here then and is here today.  Where are you, Trav?  Thank you.  (Applause.)

So was our beloved Ted Kennedy.  So were many of the members of the coalition who are here again today.  And they have worked right alongside my team and me these last seven years to refine and improve the means while staying true to the ends.  I am proud of what we and they have accomplished, and I think they’re proud, too, and ought to be.  (Applause.)

But our launch seven years ago was not flawless.  (Laughter.)  We asked an IT staffer who has been at our Connector since the beginning what the start of implementing reform was like.  And this is what he said, and I’m quoting:  “We didn’t have a complicated eligibility process back then, but we did have outages caused by traffic peaks.  We experienced some issues with data mapping of plan detail that carriers called us on.  Our provider searches were not good, and the website was a constant work in progress over the first few years.  But other than that, it was smooth.”  (Laughter.)

Any of this sound familiar, Mr. President?

So we started out with a website that needed work.  We had a lot of people with a lot of reasonable questions and not a good enough way to get them the answers.  But people were patient, we had good leadership, and that same coalition stuck with it and with us to work through the fixes, tech surge and all.  Why?  Why?  Because health reform in Massachusetts, like the Affordable Care Act, is not a website.  It’s a values statement.  (Applause.)  It’s about insuring people against a medical catastrophe.  It’s about being our brothers’ and our sisters’ keeper by helping others help themselves.

The website glitches are inconvenient and annoying.  They must be fixed and I am confident they will be.  But I hope you know, Mr. President, that the same folks who pretend to be outraged about the website not working didn’t want the ACA to work in the first place.  (Applause.)  The urgency of fixing what’s not working is, as we all know, about the American people who need simple, reliable and convenient access to information about coverage — not about silencing critics who will never be silenced.

You and the Congress looked to Massachusetts, Mr. President, as a model for how to insure working people, and through that, how to help them lead better, more productive lives.  As you turn to the vital work of making that federal IT system work, we also want to be a model for how to keep your eye on the prize, and how, working together, you put people first.  (Applause.)  The people here, all in this coalition, totally get that.

So, Mr. President, welcome to the capital of Red Sox Nation. (Applause.)  And welcome, also, to the future of affordable, accessible health care for everybody.  (Applause.)

Ladies and gentlemen, the President of the United States.  (Applause.)

THE PRESIDENT:  Hello, Boston!  (Applause.)  It’s good to be back in Boston.  (Applause.)  It’s good to be back in Boston because one of America’s best governors introduced me — Deval Patrick.  Give him a big round of applause.  (Applause.)

It’s good to see Congressman Bill Keating here.  Give Bill a big round of applause.  (Applause.)  I want to praise somebody who’s not here — I just left him — but he wears his heart on his sleeve.  He loves this city so much, and it shows in what he’s been doing for years now — one of America’s best mayors, Tom Menino.  (Applause.)

And it’s good to see all of you.  I was just at the airport — Deval was kind enough to meet me, along with Mayor Menino.  And Mayor Menino went back to city hall to work so he could wrap up in time for the first pitch.  I understand that.  (Laughter.) I am well aware that a presidential visit is not the biggest thing going on today in Boston.  (Laughter and applause.)  I understand that.  I tried to grow a beard, but Michelle, she wasn’t having it.  (Laughter.)

I am also old enough to remember a time when the Red Sox were not in the World Series three times in 10 years.  (Laughter.)  But I know the chance to win one at home for the first time since 1918 is a pretty special thing.  (Applause.)  So I promise we will be done here in time — (laughter) — for everybody to head over to Fenway and maybe see Big Papi blast another homer.  (Applause.)

And maybe the other Sox will do better next year.  (Laughter.)  You can hope.  You can dream.  (Laughter.)

The reason I’m here, though, is because this is the hall where, seven years ago, Democrats and Republicans came together to make health reform a reality for the people of Massachusetts. It’s where then-Governor Mitt Romney, Democratic legislators, Senator Ted Kennedy, many of the folks who are here today joined forces to connect the progressive vision of health care for all with some ideas about markets and competition that had long been championed by conservatives.

And as Deval just said, it worked.  (Applause.)  It worked. Health reform —

PROTESTORS:  Mr. President — don’t punish me.  For our generation, stop the pipeline!  Mr. President —

THE PRESIDENT:  Okay.  We’re talking about health care today, but we will —

PROTESTORS:  Mr. President —

AUDIENCE:  Booo —

THE PRESIDENT:  No, no, no, it’s okay.  That is the wrong rally.  (Laughter and applause.)  We had the climate change rally back in the summer.  (Laughter.)  This is the health care rally. (Applause.)

So health care reform in this state was a success.  That doesn’t mean it was perfect right away.  There were early problems to solve.  There were changes that had to be made.  Anybody here who was involved in it can tell you that.  As Deval just said, enrollment was extremely slow.  Within a month, only about a hundred people had signed up — a hundred.  But then 2,000 had signed up, and then a few more thousand after that.  And by the end of the year, 36,000 people had signed up.

And the community all came together.  You even had the Red Sox help enlist people to get them covered.  And pretty soon, the number of young uninsured people had plummeted.  When recession struck, the financial security of health care sheltered families from deeper hardship.  And today, there is nearly universal coverage in Massachusetts, and the vast majority of its citizens are happy with their coverage.  (Applause.)

And by the way, all the parade of horribles, the worst predictions about health care reform in Massachusetts never came true.  They’re the same arguments that you’re hearing now.  Businesses didn’t stop covering workers; the share of employers who offered insurance increased.  People didn’t get left behind; racial disparities decreased.  Care didn’t become unaffordable; costs tracked what was happening in other places that wasn’t covering everybody.

Now, Mitt Romney and I ran a long and spirited campaign against one another, but I’ve always believed that when he was governor here in Massachusetts, he did the right thing on health care.  And then Deval did the right thing by picking up the torch and working to make the law work even better.  And it’s because you guys had a proven model that we built the Affordable Care Act on this template of proven, bipartisan success.  Your law was the model for the nation’s law.  (Applause.)

So let’s look at what’s happened.  Today, the Affordable Care Act requires insurance companies to abide by some of the strongest consumer protections this country has ever known — a true Patient’s Bill of Rights.  (Applause.)  No more discriminating against kids with preexisting conditions.  (Applause.)  No more dropping your policy when you get sick and need it most.  (Applause.)  No more lifetime limits or restrictive annual limits.  (Applause.)  Most plans now have to cover free preventive care like mammograms and birth control.  (Applause.)  Young people can stay on their parents’ plans until they turn 26.  All of this is in place right now.  It is working right now.  (Applause.)

Now, the last element of this began on October 1st.  It’s when the Affordable Care Act created a new marketplace for quality, private insurance plans for the 15 percent or so of Americans who don’t have health care, and for the 5 percent of Americans who have to buy it on their own and they’re not part of a group, which means they don’t get as good a deal.

And this new marketplace was built on the Massachusetts model.  It allows these Americans who have been locked out to get a better deal from insurers — they’re pooling their purchasing power as one big group.  And insurers want their business, which means they give them a better deal, and they compete for that business.  And as a result, insurers in the marketplace, they can’t use your medical history to charge you more.  If you’ve been sick, you finally have the same chance to buy quality, affordable health care as everybody else.

A lot of people will qualify for new tax credits under this law that will bring down costs even further, so that if you lose your job, or you start a new business, or you’re self-employed, or you’re a young person trying several jobs until you find that one that sticks, you’re going to be able to be insured — insurance that goes with you and gives you freedom to pursue whatever you want, without fear that accident or illness will derail your dreams.

Now, this marketplace is open now.  Insurance companies are competing for that business.  The deal is good; the prices are low.  But, let’s face it, we’ve had a problem.  The website hasn’t worked the way it’s supposed to over these last couple of weeks.  And as a consequence, a lot of people haven’t had a chance to see just how good the prices for quality health insurance through these marketplaces really are.

Now, ultimately, this website, healthcare.gov, will be the easiest way to shop for and buy these new plans, because you can see all these plans right next to each other and compare prices and see what kind of coverage it provides.  But, look, there’s no denying it, right now, the website is too slow, too many people have gotten stuck.  And I am not happy about it.  And neither are a lot of Americans who need health care, and they’re trying to figure out how they can sign up as quickly as possible.  So there’s no excuse for it.  And I take full responsibility for making sure it gets fixed ASAP.  We are working overtime to improve it every day.  (Applause.)  Every day.

And more people are successfully buying these new plans online than they were a couple of weeks ago, and I expect more people will be able to buy conveniently online every single day as we move forward.  We’re going to get these problems resolved.

Now, in the meantime, you can still apply for coverage over the phone, or by mail, or in person, because those plans are waiting and you’re still able to get the kind of affordable, reliable health insurance that’s been out of reach for too many people for too long.

So I am old enough to remember when there was not such a thing as a website.  (Laughter.)  I know that’s shocking to people.  (Laughter.)  But the point is I’m confident these marketplaces will work, because Massachusetts has shown that the model works and we know what’s being offered by these insurers.  (Applause.)  We know it’s going to work.

And so far, choice and competition in the new national marketplaces have helped keep costs lower than even we projected. In fact, nearly half of all single, uninsured 18-to-34-year-olds may be able to buy insurance for 50 bucks a month or less.  Less than your cellphone bill, less than your cable bill.  (Applause.) And one study shows that nearly 6 in 10 uninsured Americans may find coverage for 100 bucks a month or less, even if they’re older than 34.

And, frankly, if every governor was working as hard as Deval, or Governor O’Malley in Maryland, or Governor Cuomo in New York, to make this law work for their citizens, as opposed to thinking politically, about 8 in 10 Americans would be getting health insurance for less than 100 bucks a month.  (Applause.)

And, by the way, it’s not just in Massachusetts.  Look at Kentucky.  Governor Steve Beshear, who’s a Democrat, is like a man possessed with helping more people get covered.  He thinks it’s the right thing to do.  Keep in mind I did not win in Kentucky.  (Laughter.)  But there are a lot of uninsured people in Kentucky, and they’re signing up.

Oregon has covered 10 percent of its uninsured citizens already because of the Affordable Care Act.  Ten percent of the uninsured have already gotten coverage.  (Applause.)

Arkansas — I didn’t win that state either — (laughter) — has covered almost 14 percent of its uninsured already.  (Applause.)  That’s already happened.

And you’ve got some Republican governors, like Governor Kasich of Ohio, who’ve put politics aside and they’re expanding Medicaid through this law to cover millions of people.

Now, unfortunately, there are others that are so locked in to the politics of this thing that they won’t lift a finger to help their own people, and that’s leaving millions of Americans uninsured unnecessarily.  That’s a shame.  Because if they put as much energy into making this law work as they do in attacking the law, Americans would be better off.  (Applause.)  Americans would be better off.

So that’s the Affordable Care Act:  Better protections for Americans with insurance; a new marketplace for Americans without insurance; new tax credits to help folks afford it; more choice, more competition; real health care security not just for the uninsured or underinsured, but for all of us — because we pay more in premiums and taxes when Americans without good insurance visit the emergency room.  (Applause.)  We get taxed.

And since we all benefit, there are parts of this law that also require everybody to contribute, that require everybody to take some measure of responsibility.  So, to help pay for the law, the wealthiest Americans –- families who make more than $250,000 a year –- they’ve got to pay a little bit more.  The most expensive employer health insurance plans no longer qualify for unlimited tax breaks.  Some folks aren’t happy about that, but it’s the right thing to do.

Just like in Massachusetts, most people who can afford health insurance have to take responsibility to buy health insurance, or pay a penalty.  And employers with more than 50 employees are required to either provide health insurance to their workers or pay a penalty — again, because they shouldn’t just dump off those costs onto the rest of us.  Everybody has got some responsibilities.

Now, it is also true that some Americans who have health insurance plans that they bought on their own through the old individual market are getting notices from their insurance companies suggesting that somehow, because of the Affordable Care Act, they may be losing their existing health insurance plan.  This has been the latest flurry in the news.  Because there’s been a lot of confusion and misinformation about this, I want to explain just what’s going on.

One of the things health reform was designed to do was to help not only the uninsured, but also the underinsured.  And there are a number of Americans –- fewer than 5 percent of Americans -– who’ve got cut-rate plans that don’t offer real financial protection in the event of a serious illness or an accident.  Remember, before the Affordable Care Act, these bad-apple insurers had free rein every single year to limit the care that you received, or use minor preexisting conditions to jack up your premiums or bill you into bankruptcy.  So a lot of people thought they were buying coverage, and it turned out not to be so good.

Before the Affordable Care Act, the worst of these plans routinely dropped thousands of Americans every single year.  And on average, premiums for folks who stayed in their plans for more than a year shot up about 15 percent a year.  This wasn’t just bad for those folks who had these policies, it was bad for all of us — because, again, when tragedy strikes and folks can’t pay their medical bills, everybody else picks up the tab.

Now, if you had one of these substandard plans before the Affordable Care Act became law and you really liked that plan, you’re able to keep it.  That’s what I said when I was running for office.  That was part of the promise we made.  But ever since the law was passed, if insurers decided to downgrade or cancel these substandard plans, what we said under the law is you’ve got to replace them with quality, comprehensive coverage  — because that, too, was a central premise of the Affordable Care Act from the very beginning.

And today, that promise means that every plan in the marketplace covers a core set of minimum benefits, like maternity care, and preventive care, and mental health care, and prescription drug benefits, and hospitalization.  And they can’t use allergies or pregnancy or a sports injury or the fact that you’re a woman to charge you more.  They can’t do that anymore.  (Applause.)  They can’t do that anymore.

If you couldn’t afford coverage because your child had asthma, well, he’s now covered.  If you’re one of the 45 million Americans with a mental illness, you’re now covered.  If you’re a young couple expecting a baby, you’re covered.  You’re safer.  The system is more secure for you and it’s more secure for everybody.

So if you’re getting one of these letters, just shop around in the new marketplace.  That’s what it’s for.  Because of the tax credits we’re offering, and the competition —

PROTESTOR:  Mr. President, ban the Keystone Pipeline!  For our generation, you need to do this!

THE PRESIDENT:  Because of the tax credits that we’re offering and the competition between insurers, most people are going to be able to get better, comprehensive health care plans for the same price or even cheaper than projected.  You’re going to get a better deal.

Now, there’s a fraction of Americans with higher incomes who will pay more on the front end for better insurance with better benefits and protections like the Patient’s Bill of Rights.  And that will actually save them from financial ruin if they get sick.  But nobody is losing their right to health care coverage. And no insurance company will ever be able to deny you coverage, or drop you as a customer altogether.  Those days are over.  And that’s the truth.  (Applause.)  That is the truth.

So for people without health insurance, they’re finally going to be able to get it.  For the vast majority of people who have health insurance that works, you can keep it.  For the fewer than 5 percent of Americans who buy insurance on your own, you will be getting a better deal.

So anyone peddling the notion that insurers are cancelling people’s plan without mentioning that almost all the insurers are encouraging people to join better plans with the same carrier, and stronger benefits and stronger protections, while others will be able to get better plans with new carriers through the marketplace, and that many will get new help to pay for these better plans and make them actually cheaper — if you leave that stuff out, you’re being grossly misleading, to say the least.  (Applause.)

But, frankly, look, you saw this in Massachusetts — this is one of the challenges of health care form.  Health care is complicated and it’s very personal, and it’s easy to scare folks. And it’s no surprise that some of the same folks trying to scare people now are the same folks who’ve been trying to sink the Affordable Care Act from the beginning.  (Applause.)  And frankly, I don’t understand it.  Providing people with health care, that should be a no-brainer.  (Applause.)  Giving people a chance to get health care should be a no-brainer.  (Applause.)

And I’ve said before, if folks had actually good ideas, better ideas than what’s happening in Massachusetts or what we’ve proposed for providing people with health insurance, I’d be happy to listen.  But that’s not what’s happening.  And anyone defending the remnants of the old, broken system as if it was working for people, anybody who thinks we shouldn’t finish the job of making the health care system work for everybody -– especially when these folks offer no plan for the uninsured or the underinsured, or folks who lose their insurance each year — those folks should have to explain themselves.  (Applause.)

Because I don’t think we should go back to discriminating against kids with preexisting conditions.  (Applause.)  I don’t think we should go back to dropping coverage for people when they get sick, or because they make a mistake on their application.  (Applause.)  I don’t think we should go back to the daily cruelties and indignities and constant insecurity of a broken health care system.  And I’m confident most Americans agree with me.  (Applause.)

So, yes, this is hard, because the health care system is a big system, and it’s complicated.  And if it was hard doing it just in one state, it’s harder to do it in all 50 states — especially when the governors of a bunch of states and half of the Congress aren’t trying to help.  Yes, it’s hard.  But it’s worth it.  (Applause.)  It is the right thing to do, and we’re going to keep moving forward.  (Applause.)  We are going to keep working to improve the law, just like you did here in Massachusetts.  (Applause.)

We are just going to keep on working at it.  We’re going to grind it out, just like you did here in Massachusetts — and, by the way, just like we did when the prescription drug program for seniors known as Medicare Part D was passed by a Republican President a decade ago.  That health care law had some early challenges as well.  There were even problems with the website.  (Laughter.)  And Democrats weren’t happy with a lot of the aspects of the law because, in part, it added hundreds of billions of dollars to the deficit, it wasn’t paid for — unlike the Affordable Care Act, which will actually help lower the deficit.  (Applause.)

But, you know what, once it was the law, everybody pitched in to try to make it work.  Democrats weren’t about to punish millions of seniors just to try to make a point or settle a score.  So Democrats worked with Republicans to make it work.  And I’m proud of Democrats for having done that.  It was the right thing to do.  (Applause.)  Because now, about 90 percent of seniors like what they have.  They’ve gotten a better deal.

Both parties working together to get the job done –- that’s what we need in Washington right now.  (Applause.)  That’s what we need in Washington right now.

You know, if Republicans in Congress were as eager to help Americans get covered as some Republican governors have shown themselves to be, we’d make a lot of progress.  I’m not asking them to agree with me on everything, but if they’d work with us like Mitt Romney did, working with Democrats in Massachusetts, or like Ted Kennedy often did with Republicans in Congress, including on the prescription drug bill, we’d be a lot further along.  (Applause.)

So the point is, we may have political disagreements — we do, deep ones.  In some cases, we’ve got fundamentally different visions about where we should take the country.  But the people who elect us to serve, they shouldn’t pay the price for those disagreements.  Most Americans don’t see things through a political lens or an ideological lens.  This debate has never been about right or left.  It’s been about the helplessness that a parent feels when she can’t cover a sick child, or the impossible choices a small business faces between covering his employees or keeping his doors open.

I want to give you just — I want to close with an example. A person named Alan Schaeffer, from Prattsburgh, New York, and he’s got a story to tell about sacrifice, about giving up his own health care to save the woman he loves.  So Alan wrote to me last week, and he told me his story.

Four years ago, his wife, Jan, who happens to be a nurse, was struck with cancer, and she had to stop working.  And then halfway through her chemo, her employer dropped coverage for both of them.  And Alan is self-employed; he’s got an antique business.  So he had to make sure his wife had coverage, obviously, in the middle of cancer treatments, so he went without insurance.

Now, the great news is, today, Jan is cancer-free.  She’s on Medicare, but Alan’s been uninsured ever since.  Until last week — (applause) — when he sat down at a computer and — I’m sure after multiple tries — (laughter) — signed up for a new plan under the Affordable Care Act, coverage that can never be taken away if he gets sick.  (Applause.)

So I just want to read you what he said in this letter.  He says, “I’ve got to tell you I’ve never been so happy to pay a bill in my entire life.”  (Laughter.)  “When you don’t have insurance at my age, [it can] really feel like a time bomb waiting to go off.  The sense of relief from knowing I can live out my days longer and healthier, that’s just a tremendous weight off my shoulders.”

So two days later, Alan goes over to his buddy Bill’s house. He sits Bill down, and his wife, Diana, at their computer.  And after several tries — (laughter) — Alan helped lift that weight from their shoulders by helping them to sign up for a new plan also.  And compared to their current plan, it costs less than half as much and covers more.

See, that’s why we committed ourselves to this cause — for Alan, and Jan; for Bill, Diana.

AUDIENCE MEMBER:  Annie.

THE PRESIDENT:  For Annie.  For anyone who wrote letters, and shared stories, and knocked on doors because they believed what could happen here in Massachusetts could happen all across the country.  (Applause.)  And for them, and for you, we are going to see this through.  (Applause.)  We’re going to see this through.  (Applause.)  We are going to see this through.  (Applause.)

This hall is home to some of the earliest debates over the nature of our government, the appropriate size, the appropriate role of government.  And those debates continue today, and that’s healthy.  They’re debates about the role of the individual and society, and our rugged individualism, and our sense of self-reliance, our devotion to the kind of freedoms whose first shot rang out not far from here.  But they are also debates tempered by a recognition that we’re all in this together, and that when hardship strikes — and it could strike any of us at any moment  — we’re there for one another; and that as a country, we can accomplish great things that we can’t accomplish alone.  (Applause.)  We believe that.  We believe that.  (Applause.)

And those sentiments are expressed in a painting right here in this very hall:  “Liberty and Union, now and forever, one and inseparable.”  That’s the value statement Deval was talking about.  That’s what health care reform is about.  That’s what America is about.  We are in this together, and we are going to see it through.  (Applause.)

Thank you.  God bless you.  God bless the United States of America.  (Applause.)

Political Musings October 29, 2013: House committee conducts hearing into health care website problems

POLITICAL MUSINGS

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OBAMA PRESIDENCY & THE 113TH CONGRESS:

OP-EDS & ARTICLES

House committee conducts hearing into health care website problems

By Bonnie K. Goodman

The House Energy and Commerce Committee started on Thursday, Oct. 24, 2013 holding hearings related to the problems with the HealthCare.gov website. The contractors responsible for developing the site testified on the first day of hearings, and denied…READ MORE
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