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tv   President Obama Discusses Health Care Law Repeal Effort  CSPAN  January 7, 2017 5:48am-7:01am EST

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his experiences legally immigrating to the u.s. and the efforts to complicated the process due to his political views. on sunday at 8:00 p.m., michael lewis on his latest book "the undoing project: a friendship that changed our mind," which looks at the work of an israeli psychologist focusing on decision-making processes in humans. it led to the creation of a field of behavioral economics. go to book for the complete schedule. a> coming up next on c-span, sitdown with president obama to discuss the health care law and its future. that is followed by "washington journal," live at 7:00 a.m. eastern with your phone calls. later, house members continue the tradition of reading the entire u.s. institution in the first phase of the new congress. >> good morning.
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welcome to the blair house. i'm the founder and editor-in-chief of vox, alongside my colleague. we're honored to be here today to speak with president obama about the affordable care act, its performance, its passage, and it's now uncertain future. i think we all prefer to hear from him, so i won't waste anymore of your time. please join me in welcoming president barack obama. [applause] >> good morning. thank you for the reporting you haven't done on the support issue. >> we will get started. expectation an
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shared among many of your staff that as the affordable care act rolled out, as it benefited millions of people, that it would become more popular. it would be safe from repeal or even substantial reform. it appears at this point he doesn't seem to be true. what do you think that they got wrong? why did to become a popular? up and sayt's back from the start that there is a reason why, for 100 years, no president could get expansion fo health care coverage beyond the work that had been done for medicare and medicaid, targeting primarily seniors. that this isn was hard. big,ealth care system is it is very personal.
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think, recognize the need for health insurance, but it's not something that they think about except when things go wrong, when you have an accident or you are sick. particularly out of time when families are feeling stressed economically, and the added costs, higher premiums, that, endsays, all up having real impact on families. the challenge of getting it that, was always the fact unlike other advanced countries, we didn't start with a system in which everybody was covered, and we have a very complicated marketplace, and the have third-party insurers. what that meant was, even after anythinge law passed,
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that dissatisfied people about the health care system could be "obamacare," even if it had nothing to do with obamacare. that was something that we recognized, even when we were trying to get the law passed. the other thing is the fact that republicansgness of in congress and around the country, including some governors, to, after the fight was over, to say, all right, let's try to make this work the way democrats did during the time when president bush tried to expand the prescription drug program, part d. public never the
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heard from those who had originally been opposed. any concession that this is doing good. and that ends up affecting public opinion. ,nd the third thing is that whatever you look at polls that 40% are are supportive, dissatisfied, in the dissatisfied column are a whole bunch of bernie sanders supporters who wanted a single-payer plan. [laughter] the problem is not that they think it's a problem, problem is that it didn't go far enough, that it left too many people still uncovered, that the subsidies weren't as rich as they should have been, but there is a way of dealing with of
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prescription drug makers and a way that drives down those costs. meant thatthings even after the law was passed, there was still going to be a lot of tough politics. having said all that, the thing that i have been most proud of is the fact that not only have we gotten 20 million people covered, not only have we atn able to reduce the pace which health care costs have been going up ever since the laws passed, basically health care inflation has been as low as it has been in 50 years, which has saved the federal government hundreds of billions of dollars, extended the years,e trust fund by 11
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bu most importantlyt, for the people who have gotten insurance through the exchanges, there's been pretty high satisfaction rates, a surveys have shown. at publicn look opinion as a whole, the thing i have been most interested in is how is it affecting the people who have gotten benefits? these are real families who have gotten real coverage. dayt letters every single from people who say, this has saved my life, this has saved my bank account, or this has made sure that my son, who got hooked on some sort of opioid, was able to get treatment, or i was able mammogram, caught cancer in time. that, ultimately, is the measure of the success of the law.
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>> do you think this dynamic, where when you reform the health care system, it goes the other way, republicans are beginning with the repeal and delay, the president-elect says he wants to repeal it, but also wants to replace it with something that covers as many people -- do you think that the dynamic in which he became responsible for what people didn't like is going to hamper republican movement in their efforts to change the system that they don't like, that has a lot of people relying on it? pres. obama: let me start from a very simple premise. if it works, i'm for it. cover allng can americans, make sure that if they have a pre-existing condition they can still get thatage, make sure
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prescription drugs are affordable, encourage preventative measures to keep people healthy, that make sure communities people have access to substance abuse care or mental health care, that medicare and medicaid continue to function effectively. if you can do all that, cheaper than we talked about, cheaper than obamacare achieves, and with better quality, it's just terrific. i'm for it. i think part of the challenge in this whole debate and this is true dating back to 2009 back to 2010. is this idea that somehow we had a fixed way of trying to fix the
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health care system that we were rigid and stubborn and wouldn't welcome republican ideas and if we only had, they had all these great solutions. in fact, if you look at how this law evolved, and i said this publicly before, if i was starting from scratch, i probably would have supported a single payor system because it's easier to -- for people to understand and manage and that is essentially what medicare is, is a single payor system for people of a certain age. and people are very satisfied with it and it's not that complicated to understand or to access services. but that's -- that wasn't available. we weren't starting from scratch. so what did i then do? i said, well, where is the system out there that seems to be providing coverage for everybody that politically we could actually get through a
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congress and where we could get republican support and lo and behold in massachusetts there was a design, bipartisan basis, including a republican governor who ultimately became the nominee for the republican party that came close to providing universal coverage. i would have thought that since this was an idea that had previously gotten a lot of republican support it will continue to get a lot of republican support. magically the mint we said, this is a great idea and it's working, republicans said this is terrible. we don't want to do this. [laughter] pres. obama: so i failed to simply make something very clear. from the very start in the
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earliest negotiations in 2009, 2010, i made clear to republicans that if they had ideas that they could show would work better than the ideas that we had thought of i'd be happy to incorporate them in the law. rather than offer ideas, what we got was a big no. we just don't want to do this. after the law passed for the last six, seven years there has been the argument we could provide a great replacement that would be much better for everybody than what the affordable care act is providing. and, yet, over the last six, seven years there's been no
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actual replacement law that any credible health care poll -- health care experts have said would work better. in fact, many would result in millions of people losing coverage and the coverage being worse for those who kept it. now republicans have to show their cards. if they have a program that would work genuinely better, and they can call it whatever they want to, trump care, mccallum care, if it actually works, i will be the first one to say, great. you should have told me that back in 2009. i asked. i suspect that will not happen. the reason is because if you want to provide coverage to
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people, then there are certain baseline things you've got to do. number one, healthcare is not cheap. for people who can't afford health care or don't get it through the job, that means the government's got to pay some money. number two, all those provisions that the republicans say they want to keep and that they like, for example making sure people can get health insurance even if they have a preexisting condition, well, it turns out the only way to meet that guarantee is to either make sure everyone had some modest obligation to get health care so they're not gaming the system or you've got to be willing to
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trust companies so that they're taking in people who are already sick. i think what we'll see now, now that you have a republican president-elect, republicans control both chambers in congress, is that all the promises they made about how they can do it better, cheaper, everybody is going to be satisfied are going to be really hard to meet. this is why the strategy of repeal first and replace later is just a huge disservice to the american people. it is something that whether you are a republican or a democrat you should be opposed to. these are real lives at stake. i am getting letters right now from people who say i am terrified because my son's or
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daughter's insurance, their ability to get life saving drugs, their ability to get drug treatment, their ability to get mental health services, are entirely dependent on us being able to afford and keep our insurance. if, in fact, there is going to be a massive undoing of what's one-sixth of our economy then the republicans need to put forward very specific ideas about how they're going to do it. people need to be able to debate it, need to be able to study it the same way they did when we passed the affordable care act and let the american people
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gauge, is this going to result in something better than what obama care has produced? and if they're so convinced they can do it better they shouldn't be afraid to make that presentation. it is really interesting to try to figure out why is it they're trying to rush the repeal so quick. what is it that they're afraid of? why wouldn't they want to say, here's our plan and show side by side, here's why our plan is better than what obama care has produced? because they have said absolutely adamantly that they can do it better. i am saying to every republican right now, if you, in fact, can put a plan together that is demonstrably better than what obama care is doing, i will publicly support repealing obama care and replacing it with your plan. but i want to see it first. \[applause] president obama: and i want third parties, objective
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people whether the congressional budget office or health care experts, across the ideological spectrum, or vox, or whoever, to just evaluate it. >> be happy to. president obama: and the public will not have to take my word for it. they can -- we can designate some referees. and if they can show that they can do it better, cheaper, more effective, provide better
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coverage, why wouldn't i be for it? why wouldn't i be for it? this idea that somehow this is about obama preserving his legacy or keep in mind i'm not the one who named it obama care. hey. they were the ones who named it obama care because what they wanted to do was personalize this and feed on antipathy toward me in their party as an organizing tool. it's politics. but i don't have a pride of authorship on this thing. if they can come up with something better, i'm for it. but you have to show, and i would advise every democrat to be for it, but you have to show that it's better. that's not too much to ask. and that's the challenge. and the question right now for paul ryan and mitch mcconnell is, why is it that you feel obliged to repeal it before you show what it is that's going to replace it? because the majority of americans have been very clear
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they think that's a bad idea. you now have republican governors, some republican senators who have said, we don't think that's a good idea. and there's been no real explanation why you would actually try to do this before the new president is even inaugurated. what exactly is this rush? particularly if you're going to delay the actual repeal? if they were making the argument this is so disastrous that we actually think we have to repeal it completely today, because it's just terrible, well, i would disagree but at least i could understand it but here you're saying we're going to vote for repeal but then we're going to delay its effects for a couple of years. well why if it's so bad? and if the answer is, well, it would be disruptive and we don't want to take people's insurance away right away, well then that means you have time to show us and, more importantly, show the american people who need health insurance what exactly you're replacing it with. in that sense, i know that was a
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long answer, ezra, but in that sense the answer is, the republicans, yes, will own the problems with the health care system. if they choose to repeal something that is providing health insurance to a lot of people and providing benefits to every american who has health insurance, even if they're getting it through the job, and they haven't shown us what it is they're going to do, then they do own it because that is irresponsible. and even members of their own party, even those oppose today me have said that is an irresponsible thing to do. sarah: let me follow up on the congressional fight. >> we saw yesterday
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president-elect donald trump said on twitter "it is time for republicans and democrats to get together and come up with a health care plan that really works" which is something i remember you saying similar things in 2009 and 2010 when i was covering this debate. knowing what you know now about partisanship, being a president, trying to do this, like you said unable to get republican votes, what three pieces of advice would you give someone trying to attempt to pass a bipartisan health care law? president obama: well, look. i think i sort of gave the advice just now. which is if, in fact, this is not about politics but this is about providing the best possible health care system for the american people, then my advice would be to say, what precisely is it about obama care that you think doesn't work? because you've already said there are some things you think do work. all right? the republicans keep on saying,
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well, we want to keep the things that people like and that are working well, so they think it's a good idea obama care says your kids can stay on your health insurance plan until they're 26. they think that's a good idea. they think it's a good idea that if you've got a preexisting condition you can still get health insurance. i assume they think it's a good idea that seniors have gotten discounts on their prescription drugs. we closed the donut hole during the course of obama care. they approve of some of the changes we've made to encourage a healthier system that rewards quality rather than just the number of procedures involved. and how we pay providers. so we could make a list of all the things that as terrible as obama care is, actually they think works according to them. let's make them a list of the things they don't like or the american people are concerned about. what we know is that people would always like lower costs on their premiums and their out of pocket expenses.
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and although the affordable care act provides a lot of subsidies to a lot of people so they can afford health insurance, what is absolutely true is we would love to see even higher subsidies to relieve the costs even more. but that costs money.
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what we also know is that where we've seen problems in the implementation of the affordable care act it has been in certain areas, particularly more rural areas, less densely populated areas, where we're not seeing as many insurers. so there's not as much competition. well, one way that we've suggested you could solve that problem is to say that if in fact there aren't enough insurers to drive competition and reduce costs, and give people enough choices, then we should have a public option that's available. so if you look at the things that people are frustrated about with obama care, the affordable care act, the big things are the subsidies aren't as high as they'd like and they don't have as many options as they'd like. i'm happy to provide both those things. i'd sign on to a republican plan that said we're going to give more subsidies to people to make it even cheaper and we're going to have public option where
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there isn't an option. here's the problem. i don't think that's the thing they want to do. \[laughter] president obama: i guess my point is this, that it is possible for people of good will to try to come up with significant improvements to the law that we already have, but it does require to be specific about what it is that you think needs to be changed. and that, so far, has not happened. and my advice to the president-elect, in fact, we talked about this when i met with him for an hour and a half right after he got elected. i said, you know, make your team and make the republican members of congress come up with things that they can show will actually make this work better for people, and if they're convincing, i think you would
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find that there are a lot of democrats out there, including me, that would be prepared to support it. but so far at least that's not what's happening. ezra: i think obama care has exposed an interesting tension between controlling costs in the system and controlling economic pain for individuals. the law has until now come in under budget. part of the way it's done that is higher deductibles than people expected, higher copays. in a couple years if it does please the change the excise tax on high value insurance will come into play, the individual mandate and these things to individual people while they keep the usage and cost of health care down they make health care feel more expensive. they make health care feel unusable. do you think the affordable care act got the balance right on controlling system wide costs
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versus insulating individuals from their health expenses? president obama: well, let me make a couple distinctions. first of all, part of what happened at the beginning of the market places, for those who aren't wonks, this is like a wonkapaluza. some serious policy detail here. market places are basically just those places where insurers put up, here's, you know, here's the insurance package we're offering and you can choose from a variety of different packages and then once you've chosen you
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can figure out the subsidies that you're qualified for and they'll give you a sense of what your out of pocket costs are. and what we've discovered was that a lot of insurers under priced early on because they have done surveys and people were purchasing health insurance like everything else. they'd like to get the best deal for the lowest price. what makes health care tricky is when you buy a tv you can kind of see what the picture looks like. when you're buying health insurance it is tempting to initially buy the cheapest thing until it's, heaven forbid, you get sick and it turns out, gosh, i can't see the doctor i want or the specialist i want or, you know, this is more inconvenient than i expected. so what ended up happening was people bought often times the
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cheapest insurance that they could, insurance companies wanting to get as much market share as possible, and ended up creating a very low cost plan but those are going to have restrictions on them. and that's not just if you're buying health insurance in obama care. that's generally how it is even when employers buy health insurance for their employees. now, i think that what we're seeing is insurers now making adjustments, saying, okay. we need to charge more. and that is something that the good news is appears to, may have stablized. that may be kind of a one-time thing. now we're in a position to be able to do an evaluation of, have we gotten this balance right, as you say. we can't get health care for
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free. you're going to have to pay for it one way or another. either the government is going to pay more so people don't have as many out of pocket costs, or -- and that means in some fashion higher taxes for somebody -- or individuals are going to have to pay more out of pocket in one way or another. the same is true for employers. you know, either employers pay more for really good health care packages, but that takes something out of the employer's bottom line, or they're putting more costs on to workers in the form of higher deductibles and higher copays. and i think that a lot of the good work that can be done in lowering costs has to do not with cost shifting but with actually making the system work better. we've done a lot of work on that.
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what i referred to earlier incentivizing a system that instead of ordering five tests because doctors and providers get paid for the tests you now have a system where you're going to -- you now have a system where you get reimbursed if the person gets healthy quicker and does not return to the hospital. well, it turns out that can over time be a real cost reduction. those are the kinds of things we're implementing in the system as a consequence of obama care. the more we do that kind of stuff, the less we're going to see this cost shifting. but the intention has never been to say, let's make it more expensive for people to get health care so they're going to access the system more. i think the proof of that is that even though per person costs have not gone up a lot,
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the overall spending on health care has gone up because more people have come into the system. we want people to use the health care system. we just don't want them to use it in the emergency room. we want them to use it to stay healthy and smoking cessation plans and making sure they're getting regular check-ups. and mammograms and, you know, those are the things that are ultimately going to save us as much money as we can. sarah: one followup question. what about controlling prices? we have some of the highest health care prices in the world in the united states. most other developed countries regulate how much you can charge for m.r.i., an emergency room visit, appendectomy. that seems like it is really at the core of the tension the fact that we have these very high prices. americans don't go to the doctor more. we just pay a lot more when we
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go to the doctor. that is something the health care laws did not affect. what do you think of the role of price control in american medicine? president obama: look. this is the irony of this whole debate is the things that people are most dissatisfied with about obama care, about the affordable care act, are things that essentially in other countries are solved by more government control not less. and so republicans are pointing at these things to stir up the satisfaction but when it comes to what's the solution for it, their answer is less government regulation and letting folks charge even more in doing whatever they want and letting the market place work its will. i think that there are strengths to our system because we have a more market based system. our health care system is more innovative.
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prescription drugs is probably the best example of this. it is true that we essentially come up with the new drugs in this country because our drug companies are fat and wealthy enough that they can invest in the research and development. they make bigger profits which they can then plow back into drug development. and essentially we have a lot of other countries that are free riders on that system. so they can negotiate with the drug companies and force much lower prices but generally don't have a drug industry that develops new drugs. that's true. this is an example of where you probably do want some balance to maintain innovation but to add some tougher negotiations around
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the system as a whole. we are trying to use medicare as the place where there's no health care provider or stake holder in the health care industry that doesn't in some ways want to get medicare business. we're trying to use medicare as a lever to get better deals for consumers and better prices for consumers not just those in medicare but also people throughout the system. as i said shall the irony is when we try to do that the people who are most resistant are the very -- the republican members of congress who are criticizing us or at least telling the american people that you should want lower prices on various procedures. if we want to control prices for consumers more then the market place by itself will not do
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that. and the reason is health care is not exactly like other products. it's not like buying a flat screen tv. if you're sick, or if your kid is sick, most of the time you're not in a position to negotiate right there and then. you can't walk out the store and just say i'm going to see if i can get a better deal. you're trying to figure out when sasha got meningitis when she was 4 months old, make my child better. and that's all -- worry about the cost later. that's the mentality most people have when it goes to health care. so the traditional models of the market place don't work perfectly in the health care system. there are areas where we can
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increase market place competition. there are ways in which we can make it work better. but ultimately if we want to really get at some of these costs there has to be some more extensive regulation than, in certain areas than we currently have. sarah: so i recently took a trip to an area of kentucky on a totally different topic. i saw huge coverage gains under the health care law also voted overwhelmingly for president-elect trump. one of the people i met there is here with us today. she is an obama care enrollment worker who signed up more than a thousand people for coverage. she supported you in 2008 and 2012 but voted for president-elect trump in 2016 and expects him to improve on the affordable care act. she would like to ask you a question about that. president obama: go ahead, kathy. >> hello, president obama.
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i'm so excited to meet you. president obama: good to see you. >> thanks. i am a little bit nervous as you can see. over the years i've enrolled and talked to numerous kentuckyians and i've signed up some for even the first time, so was working affordable care act. and, also, we've been going over the years and i've talked to people but recently we've found out that there were choices in our area and the increase in the premiums and deductibles and our facilities aren't even taking some of them. and many kentuckians now are looking at the affordable care as unaffordable and unusable. and i had the opportunity to ask you a few questions that you have probably went over but how do you think this happened? how can we fix it?
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do we start all over again? what do you think we should do? president obama: well, first of all, i want to thank you for being out there enrolling people. that's been hugely important. \[applause] the second point i would make is that kentucky is a place where this has really worked and it's worked for two reasons. one is kentucky expanded medicaid and we haven't talked a lot about that but a big chunk of obama care was just making medicaid accessible to more people. and those states that expanded medicaid have seen a much bigger drop in the uninsured than those states who didn't.
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and, by the way, those states that didn't, they didn't do so just out of politics. i'll just be very blunt. because the federal government was going to pay for this medicaid expansion. and states, some states, because they had all this uncompensated care and ended up making money by providing more health insurance to your people. it was a hard bargain, a hard deal to turn down and, yet, you got a number of states that turned it down mainly because republican governors and republican state legislatures didn't want to make it work. kentucky, was one of those people that did expand medicaid, had a really active program, because i don't poll that well in kentucky, they didn't call it obama care.
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they called it kentucky connect, right? and so there were a whole lot of people who said we don't like obama care but i like this program. we'll sign you up. you signed people up. you didn't tell them it was obama care all the time. and it actually worked, right? now, what is true in kentucky is true in some other states. you had a governor who ran on the idea of rolling back obama care. even though it was work. and so the state market place, the state exchange, he dismantled which means we had to shift everything on to the federal exchange. most people got shifted. it indicated a lack of interest and effort on his part in making the thing work. he promised to roll back medicaid but started realizing
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that wasn't as good politics as he thought when he was running so he hasn't done that. but what is also true is, and this is my main criticism of obama care, of the affordable care act, is that the subsidies aren't as high as they probably should be for a lot of working people. if you don't qualify for medicaid where you don't have to pay for the most part for your coverage, and instead you're buying health insurance on the market place, so you're working, a working person but you don't have a lot of money, and particularly if you are older where you use the health care system more, and you need a better benefit package than somebody 18 or 20 might, then there are families where the
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premiums are still too high. as i said earlier, there are some parts of the country where there are only a handful of hospitals and a few doctors and where you don't have a lot of competition and the insurers are looking and saying we're not going to make a lot of money there so you don't end up with a lot of insurance plans in those areas. so the two things we could do that would really make it work even better for people in kentucky would be, number one, provide more subsidies to folks who are working hard every day but still find the premiums even with the subsidies hard to meet and have the public option for those communities where they're not getting a lot of competition. and insurers aren't coming in. the problem is that's not what is being proposed by mitch mcconnell the senator from kentucky. instead what he is proposing i
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gather is you're going to repeal the law. then you're going to come up with something except you will have taken away all of the -- the way we pay for the subsidies for working people is we're taxing wealthier folks a little bit higher. so he wants to cut those taxes, and that money is -- that money would be gone right away. and then he is going to promise you or those people who you've been signing up better health care except there is not going to be any money to pay for it. nobody has explained to me yet how that's going to work. and so i think this takes me back to the point i made earlier. if, in fact, the people you've been signing up, the folks in
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your communities, are not fully satisfied with the benefits that they're getting now, and are hopeful for something better, then at the very least you should be putting pressure on your members of congress to say, show us exactly what the deal is going to be for us before you take away the deal that we've got. because the people you sign up for may not be as happy as they'd like, but tell me if i'm wrong, they like it better than not having any insurance at all. and some people didn't have insurance and -- because i get letters from folks who say, for the first time in my life, i have had a bad hip for 15 years and i've been pain free for the first time because i finally got insurance. right?
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so i -- the answer is not for them not to have insurance. and if we go back to a system where they've got to buy it on their own, they're not going to buy it because they'll have even less subsidy. how much time do we have? ezra: i think we're quite low. president obama: because i got all kinds of more stuff. ezra: it's your schedule. we can keep you as long as you'd like. president obama: well, why don't you -- there are a couple points i want to make in closing. but why don't you ask some questions. ezra: one thing we haven't touched on yet in much detail is the delivery system, a big part of the law.
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so what is a policy or experiment or change in that space that has over performed your expectations and what is one that has maybe not panned out as you like or hoped? president obama: i think a good example of something that's worked better than we expected or at least worked as well as we expected is the issue of hospital readmissions. now, it turns out that a lot of times you go to the hospital, let's say you get your appendix taken out. and then you go home and then there is a complication and then you have to go back and into the hospital. that's obviously inconvenient for you and it's expensive for the system as a whole. and it turns out that there are just a few things that you can do that help reduce people being readmitted. first of all, making sure that the first procedure goes well. but, secondly, making sure there's good followup.
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so it might be that a hospital or a health care system pays for when you do go home you just get some phone calls to remind you to take the medicine that you got to take to make sure you heal properly. because, you know, they may have done a study and it turns out that people forget to do what they're supposed to do. they don't follow exactly their doctor's instructions. they can't afford to have a nurse in their house who is doing it for them. well, maybe there are just a few things that can be done that help make sure that they do what they are supposed to do and that way they don't have complications. what we've seen is a significant reduction in hospital readmissions over the course of this law just by doing some smart incentivizing. just saying the hospitals won't reimburse you or will give you some other benefit for doing smart followup. that's an area where i think we've made some real progress. the other place, and this is connected, where i think we've got some good bipartisan support
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is just encouraging what's called the shifting from what's called fee for service payments where you get paid by the procedure, which means that you may end up getting five tests instead of getting one test that's e-mailed to five providers who are treating you. and we've started to see some real movement when we say to the system as a whole, we're going to pay you for outcomes. did the patient do well? that has been helpful. in terms of areas where i think we haven't seen as much improvement as i'd like, it is probably one thing that comes to mind is on the electronic medical records, give me -- if you think about how wired and plugged in everybody is now, you can basically do everything off your phone. the fact that there are still just mountains of paperwork and you don't understand what these bills are that still get sent to your house and nobody -- and the doctors still have to input stuff and the nurses are spending all their time on all this administrative work, we put a big slug of money into trying to encourage everybody to digitalize and catch up with the
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rest of the world here. it's proven to be harder than we
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expected partly because everybody has different systems. they don't all talk to each other. it requires retraining people in how to use them effectively and i'm optimistic that over time it's inevitable that it is going to get better because every other part of our lives, you know, become paperless. but it's been a lot slower than i would have expected. and some of it has to do with the fact that as i said it's decentralized and everybody has different systems. in some cases you have economic incentives that are pushing against making the system work better. for example there are service providers. people make money on keeping people's medical records. and so making it easier for everybody to access each other's medical records means that there are some folks who could lose business and that has turned out to be a little more complicated than i expected. sarah: do you have any closing remarks? one thing i am interested in is kind of what you see your role in this debate we're gearing up for as. president obama: let me make a couple closing remarks.
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number one, i think it is important to remember that just because people campaigned on repealing this law it is a much more complicated process to repeal this law than i think was being presented on the campaign trail as my republican friends are discovering. the way this process is going to work, there is this rushed vote that's taken place this week, next week, to, "repeal obama care." but really all that is, is a resolution that is then instructing these committees in congress to start actually
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drafting a law that specifically would say what's being repealed and what's not. then after that they have to make a decision about what's going to replace it. and how long is that going to take? and that stretches the process out further. and so i think whether you originally supported obama care or you didn't, whether you like me or you don't, the one thing i would just ask all the american people to do is adopt the slogan of the great state of missouri, show me. \[laughter] >> show me. do not rush this process. and to republicans i would say, what are you scared of? if you are absolutely convinced
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as you have been adamant about for the last seven years, that you can come up with something better, go ahead and come up with it. i'll even cut you some slack for saying you're going to come up with something better for seven years and i've never seen it. we'll restart the clock. if -- we're here in blair house because this is a place where i met in front of the american people with republicans who had already indicated their adamant opposition to health care and i sat with them for a couple hours. how long was it? eight hours. for eight hours on live tv to talk about why we're trying to do what we're doing here and challenging them to come up with better answers than the ones
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we've come up with. we've spent a year of really significant debate and i would think that given we now have proof that 20 million people do have health insurance that we're at the lowest rate of uninsured in our history, that health care costs, rather than spiking way up actually have gone up slower than they have in 50 years, given the vast majority of people who get health insurance through obama care have said they're satisfied with their care, and that they're better off than when they didn't have care, given that even though a lot of people don't know it even if you're not getting health insurance through obama care you've benefited because if you get health insurance on the job it now doesn't have a lifetime limit. it doesn't have fine print that could end up costing you a lot of money.
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given all those things, i would think that you at least would want to explain to the american people what it is that you want to do. and that, i think, is a minimum expectation out of this congress and out of the president-elect. i'd make a second point. and that is that we just worked on a bipartisan basis to sign something called the cures bill that included two really important bipartisan priorities. one was joe biden's cancer moon mission because we are seeing so many medical breakthroughs in so many areas that we have an opportunity to make a real dent in how we deal with cancer, which affects everybody. in some fashion. somebody's been touched in your family with this terrible disease.
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so we got a lot more money for research in that, and the bill also contained a big investment in the opioid challenge. as many of you know, you're seeing more and more communities that are being ravaged by initially prescription drugs, then that ends up being a
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gateway into heroin some of which like synthetic heroin is being produced called fentanyl just has terrible rates of over dose deaths. and this is not an inner city problem, per se, but this is reaching every community. in some ways it's worse in a lot of rural communities. so there was a bipartisan effort for us to put more money in the net. but here's the thing. if we just put money into cancer research and we just put money into dealing with the opioid prices, and now we're taking away money that is providing drug treatment services, in those very same communities, by repealing obama care and taking away the ability to access a doctor to get new cancer treatments, then we're really not helping anybody. that is a second point i want to make. a third point is that i would encourage local communities to get involved in the process and i think part of the problem with this whole law has been that the people who benefit aren't out there making noise and the people who idiosyncrasy logically opposed this -- who ideologically oppose this had have been really loud. now is the time for people who have benefited or have seen their families benefit to tell
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their stories because ultimately this is not a political gain. this is really something that affects people in the most personal ways. my friend is here in the front row. some of you heard natoma's story before, a cancer survivor who because she had now preexisting condition was faced with either keeping her health insurance at such a high rate the only way she could get health insurance for the preexisting condition was to basically pay so much that she could no longer afford to pay the mortgage on her house and i remember her writing to me
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and i thought, you know, that could be my mom. that could be yours. and that's not a choice people should have to make. and when most people, even if they're not obama supporters, hear natoma's story or the stories of other people who have been helped, they know it's wrong to just take away their health care. and it becomes less about who's winning here in washington and becomes about how we're doing right by our fellow americans. but those stories have to be heard. and i would just encourage people to start telling their stories and tell their stories, you know, you're not always going to get a lot of attention in washington because they want to know this vote and this insult hurled back and forth between whoever. but you know what?
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tell that story in your local newspapers. talk to your local reporters. you know, congregations. that are involved in caring for those in need. make sure that you're telling stories in church and services, so that people know because the one thing that i am convinced about is the american people want to do the right thing. it's hard to get good information and -- unless you're reading vox every day, which is hard to do --. ezra: not hard to do. president obama: yeah. getting all the details of all this policy is hard. it's complicated. you don't know what's true. you don't know what's not true. those folks in kentucky you signed up, there are a lot of
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people who voted for not just president but also for a member who said explicitly we're going to eliminate this. i understand why people might think okay. he's going to eliminate it but he will give us something better. but this is hard. you know, and what you don't want is a situation where they make a promise that they can't keep. and i worked on this a long time. if we had had a better way to do this, we would have done it. it would have been in my interests to do it because i knew i was going to be judged on whether or not it worked. and those areas that don't work have to do with there not being enough money in the system and
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not adding a public option. i'm more than happy to put those fixes in place any time any place but that is not so far what the republicans are proposing. you deserve to know what it is that they're doing. so, anyway, i appreciate you guys taking the time to -- ezra: real quick tell us about your role going forward. president obama: my role going forward? well, look. i mean, i do deserve a little sleep. and i've got to take michelle on vacation. and so -- but i've said consistently that the most important office in the democracy is the office of citizen. and i will be a citizen who
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still remembers what it was like when his mom died of cancer, younger than i am now. and who didn't have all of the insurance and disability insurance and support and wasn't using the health care system enough to have early detection that might have prevented her from passing away. michelle's dad had multiple sclerosis but was part of the generation that didn't have a lot of expectations about health care so just kind of suffered and, for years, i mean, those are our stories. so it's not like i'm going to suddenly fade away on this. i will be a part of the work of our fellow citizens in trying to make sure that the wealthiest
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country on earth is able to do the same thing that every other advance country is able to do. it's not as if this has never been done before. if you're canada you got health care no matter who you are. if you're in trans you got france you got health care. if you're in england you got health care. if you're in australia, you got health care. if you're in new zealand you got health care. i remember talking to my friend john key who was the prime minister of new zealand. he is part of the conservative party in new zealand. and he said to me in the middle of this health care debate, he said, if i propose that we took away people's health care, that we repeal it, i'd be run out of office by my own party. \[laughter] president obama: because it was just assumed that
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in a country this wealthy this is one of the basic rights, not privileges, of citizenship and in a well-to-do country like ours. so i'll be working with all of you. but my voice is going to be less important than the voices of people who are directly affected. and so i would urge everybody to make your voice heard. now is the time to do it. the people who have opposed this were opposing it not based on facts but based on sort of an ideological concern about expansion of the state and sort of taxes on wealthier people that are helping people who don't have as much money and i respect their role in the
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democracy. they've been really fighting hard. folks here got to fight just as hard. my final piece of advice would be to the news media, which is generally speaking when obama care has worked well, it wasn't attributed to obama care. and when there were problems they got front page headlines. i think that hopefully now is a time where people can be -- this doesn't apply to vox by the way, but i think it would be a good time for people to be a little more measured and take a look at what are the facts of this thing? because the stakes are high. even on this whole premium issue, increase issue that happened right before the election, it is true as i said that insurers adjusted and hiked premiums but i kept on trying to explain number one --.
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if you are getting a tax subsidy, this was not going to affect your out-of-pocket costs but nobody heard that. a number to come these increases in premiums only apply to people that i health insurance on the exchanges. getof the people do not health insurance from obamacare. your health care premiums have ofe up a lot less since obamacare was passed. the average family has saved about $3000 in lower health care premiums. i did not see a lot of headlines about that. which i understand. it is not controversial enough.
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or it is a little bit too complicated to get that soundbite. so that is why individual voices are so important and why i am so appreciative of journalists who actually know what they are talking about. [applause] >> thank you mr. president. [applause]
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[applause] >> coming up here on c-span, washington journal is next. and house members continue their tradition of reading the u.s. constitution in the first days of the new congress. later on today's "washington journal," we'll take a look at today's president-elect donald trump pick for secretary of state with bradley olson of the "wall street journal." after that, paige cunningham of the "washington examiner" talks about washington effort to repeal the affordable care act and how the law might be replaced. and a look at the scholarship program in kalamazoo, michigan,
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that allows public school student to attend college for ree. [captions copyright national cable satellite corp. 2016]] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit] host: good morning. here are your top headlines. the alleged gunman in the mass shooting that left five dead is in federal custody. he is scheduled to appear in court on monday. trump tower u.s. intelligent official told president-elect donald trump that russia used cyber attacks to -- u.s. election. and donald trump criticized automakers for making in mexico instead of the united states. he promises to build america's manufacturing sector but what's the best way to do that? that is what we're asking you this morning. here is


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