tv CQ Roll Call Hosts Discussion on the Future of Affordable Care Act CSPAN November 10, 2016 9:04pm-9:49pm EST
is all the military, etc. at the end of the day, you have to beg, borrow, or plea for your agenda, even with come as many presidents have discovered, even with the relatively friendly congress. question notis a really about is the talent there. this is a question about, what does donald trump do in the transition from a business executive to a political executive? they are two very different things. that, maureenon dowd, a fabulous writer -- i don't necessarily agree with what she writes -- but she made a really important observation about this. washington, however you want to describe all of us in our establishments left and right, --y political infrastructure and the political
infrastructure, took donald trump, but never took him seriously. and trump the voters and conservatives took trump seriously, but never literally. the notion that he will be at war with the establishment is just not true. if you look at -- donald trump has proposed tax refund that is right down the line with what the republicans think. he has talks about education in line with what the republicans think. you go down a list of things, the military, the v.a., not as much of a difference. there is a style difference. opposition, you can think about where things go, but the first 100 days is critical. the power of the president in the first 100 days is enormous.
the things you pick, president obama picked health care. he picked a stimulus package that could have had wide bipartisan support. he chose not to work with the republicans on it. donald trump i think will surprise people, and that there will be democrats who will understand what this election realize, i have to be a part of this a little bit. after all, if you are a member of congress, generally speaking, i don't say this in a disparaging way, your first priority is to be reelected. it will be very difficult in most district in the country to say, we don't care what the voters just said. we are not going to keep on this path. but you just listed a list of very conventional which i think you get some democratic support for as well. the things that donald trump
campaigned on how to do with a rather radical approach to immigration, and a radical, radical approach to mexico and to illegal immigrants. i would think that his voters will be looking to see, in his first 100 days, what does he do about that? how many people does he deport in his first 100 days, and how much of the wall gets built? come on, that's what he ran on. literal? seriously. this morning the canadian ambassador said, yes we are happy to talk about renegotiating nafta. immigration -- i did this when i was in the white house, and when i was with john boehner i'm not going to say. it is not hard. at the components are the same. you have to do something about
border security. saying i'm going to build a wall, you could take it literally, or you can take it seriously, just like the obama team did or the bush team. how do you secure the border? if you talk about what are you going to do, whether you call them illegal or undocumented, the fact is there's 13 million or whatever the number is, you have to figure out a way to handle it. nobody believes you will round up 13 million people. it is a wonderful hyperbole. i know a gets msnbc feeling good about this, but it's not realistic. >> one other thing i think many trump voters expect him to deliver on is the supreme court. there's absolutely no question that of a portion of the evangelical community, the social conservative community who were uncomfortable with him for many reasons, decided to hold their nose, because they wanted another scalia on the court.
what i'm looking for right away is who is his nominee? if he nominates william pryor or , thate else on this list compared gay people to howphiles, and talked about that's just like beastie allergy, i think you will -- bestiality, you will have a big problem with the democrats on the senate, and you won't get to talk about tax reports or other things. >> how much is this? that is something they can deliver. pressure does he put on leader mcconnell to perhaps change senate rules to make a nomination more accommodating? you look at the first 100 days in three different tracks. they have different speeds. the first is what can president-elect trump dubai executive order?
that can move insanely fast. i think it would be a very active first week or two weeks of the administration. to the point that i would not be surprised if the inauguration festivities themselves are not truncated or don't take a different kind of view, because he's going to be that busy and wants to make the effort. the next fact is the house. that is the implementer of the president's agenda. there is a lot of overlap. aca.e repeal of some us to be done administratively, some legislatively. that keeps the party united. i think education keeps the party united. i think you can move a budget bill earlier than typically, to get reconciliation. .hat moves very quickly
then, you have the third and slower track, the senate. the senate will be slower for a lot of reasons. it will be slower because they have to appoint all of these nominees and because the supreme court will probably happen in the first 100 days. i think it is less of what trump maybe he nominates will change things. but it is how the democrats react. i can't imagine mcconnell will go up there and change the rules, unless he feels the democrats are forcing him.and if that happens , that changes the way we look at the second 100 days and the third 100 days, and everything forward. it will be a calculated risk the democrats make on how hard to push. it will be a calculated risk that trump makes on how hard he wants to go. there is a real likelihood that this is the first of at least
two, and probably three justices, he will get a crack at. is this where we throw down the dice, or do we keep going? elaine: let's focus for a minute on the aca. in his first 100 days, he said they are not doing it right now, they will do a piece of legislation to repeal the aca. the minute and lands in congress people will discover,, you know, there were things about the bill that people really like. that ane the fact insurance company could not turn you down for a pre-existing condition. and the minute congress starts hearing from his constituents, and pulling out things from the the nextat they like, step is that the insurance companies are going to go on a ballistic.many insurance companies that supported republicans are going to go crazy . the deal that held that together
was insurance companies would take more sick people, in return for getting a bigger market because of the subsidies in the aca. i'm going toimple, repeal it and the congress will repeal it. there are many conquered -- complicated steps ahead. i would like to quote president bill clinton, whose white house i worked in. he said of the presidency, they alleged you to look down the street and around -- they elect you to look down the street and around the corner. i think that's the hardest thing about the job. i think president-elect trump or any president finds that the most difficult and frustrating part of the job. i will quote president obama. i have a pen and a phone. you live by that, you will die by that. the truth is, you don't have to pass a piece of legislation right away. you think about all the things
-- if we are being intellectually honest, and not just mimicking talking points, what we know on both the democrat side and the republican side is from the time aca was first put into law, there were obvious problems with it. and everybody knew you needed technical fixes, and whatever. there was a political decision made not to go to congress, because we don't want to risk losing anything we thought we want. the cost of that now is, guess what? every phone call and pen action they took is now gone. the collapse of aca is actually brought on by how the obama administration decided to implement this. once that happens, i have not heard of a single republican who said, we also have to repeal the existing conditions. none of them have said that. but that's the point.
the minute you let that stay, but repeal all the subsidies that constitute obamacare, you have an insurance industry in crisis. brian: this is a very mature debate. debate that congress and ways and means, and energy and commerce, and health and finance -- they have been having this debate for years, since before it became a law, and then when it became a law, and certainly after. the republicans have been made fun of art for trying to repeal it 45 times. within that, you have paul ryan's agenda, which lays a formative path. you do have michael burgess and tim murphy, and others in the house and senate who have laid forward either whole chunks of what replace would look like, or what small segments would look
like. believe me, i'm a lobbyist. i get paid to do this. the insurance companies have been lobbying for changes since it got started. it's not like the repeal will be god, they are going to do this. it is a mature debate. there are mature debate of their.this will not shock any of the stakeholders. it may shock any of the american people, but not question can -- washington dc. >> the point being there are two steps. the political problem of potentially taking away coverage for millions of people, and or you have to spend huge sums to stabilize markets. this is something that plays out in two acts? what do you think? barry: yes. we came up with this idea of one
step closer, single pair and what they see it. it's not working. it is clearly not working. that is why you have most major insurance companies paying -- saying, we are out of here. even before the election. the notion that there is this snap fit, is ludicrous. you are going to start with some things in executive order on day one. for the next 10 days, whatever it is going to be. then what are the key things -- again, the rhetoric of, you will throw 43 million people out of health -- come on. if you want to fix a problem, but set aside the nonsense, what is the real problem here? >> and i want to go back to setting aside the nonsense. you also said you think there will be an easy way to pass a budget very quickly. i'm not sure if that is true.
i think there are a lot of thele who are sitting in capital who are republicans, who want a lot of budget writers, that democrats will stand up and filibuster. we have already seen on the defense bill right now that came out of the house, we see a writer that would allowed discrimination against lgbt people, and overturn several things president obama did, to make sure they were not discriminated against. that will continue to be a debate. donald trump said he supports those kinds of things, he supports the first amendment defense act. i don't think 48 democrats are going to let that happen. if there is budget writer about the funding transparent it -- defunding planned parenthood, which he promised his supporters, that is not something you can get with 52 in the senate. -- need to knew a lot better
do a lot better to get that done. there are a lot of democrats feeling very united. we know what we are up against. there's a lot of unity around standing up to protect people who donald trump's campaign rhetoric through under the bus. -- threw under the bus. elaine: let's go to the question that confronts everyone, all republicans elected. the republicans have been in charge with some regularity since 1994. is the government any smaller than it was? no, it's not. it spends more money and it has more people. because the bottom line is that even the republican party, when they sit down to do a budget, cannot shrink the government. they have not been able to do it. john boehner had a $1.2 trillion, 10 year cut in the size of government, the largest
in dollar terms, and percentage -- elaine: and has been progressively put back.every time the republicans do this -- barry: the democrat president insisting on it. elaine: no. reality sets in. reality is fewer tsa agents at the airports, causing mammoth chaos. guess what? they put back the money. reality is the soldiers needing care. they put back the money. the republicans have failed time and time again, for 30 years now, add their own goal of cutting the federal government. take a step back. we are arguing about appropriations, and appropriations are not going to happen in the first 100 days. -- they they probably will not happen on a lame-duck either. when i see budget, it is a
partisan budget that does not need the support of a single democrat. we could have 200 different votes that are probably all horrible, but in the end, if the republican party says we want a budget, they will get a budget. in that budget is most likely reconciliation instructions. that is the real reason the budget document moves. -- it willve a say whatyou 302a, and tell you the aprops are going to be. to get war first is reconciliation. the reason they want that is to go after aca, and maybe do taxes if they can. everyonestructure bill seems to talk about is also dependent on this budget. the budget itself, it can move very fast. i actually think the democrats will participate in that debate
actively. the writers are really the vote ramas we get at the end. adriel: what is the role of the house freedom caucus? they could not get on the same page, there was a civil war with the house gop budget. is it a total real -- reset? what role do you expect the fortysomething members to go for? barry: washington is having a hard time wrapping their head around, is president trump. the freedom caucus, all of a sudden their ability to be some kind of lead voice, is just greatly diminished. remember this. even two weeks ago, people were still, speaker ryan is probably going to lose 15-20. there were only six seats. those were largely because of the individual issue or redistricting. those are very powerful messages
to house republicans. we had a chance. it doesn't mean the freedom caucus goes away, or walk away from their principles. brian wask just as outlining, the gate are unifying issues for house republicans and senate republicans. everyone will be -- want to be part of the winning team. brian: i think there's a misunderstanding in bc on how republicans are split. d.c. on how republicans are split. i think there is a split on immigration, but there are freedom caucus members for immigration and against it. most of it is split -- most of the split in the republican party, you go from leadership and move down the line to the right, and mainstream partnership people, and then to caucus, and the freedom
and the nine people who voted on the ryan for speaker far right, most of that split is on strategy. it is a split that says the further right you go, you don't want to cut a deal, period. that no deal is better than any deal that gives democrats a thing. the for closer you get to leadership, the closer you get to, i'm willing to get a deal. it is a strategic divide. now that you have trump, who is saying this is our strategy, which is what i think he will say, that divide goes away. and yes, there will be republicans losing on certain things. strategically, republicans will be united, and that takes away a
lot of what has been misinterpreted as a divide. lanae: i think that's only true if you are talking about aca and maybe taxes. when you go down the like other issues -- line to other issues like trade, there is a mammoth split the republican party and democrat side around trade, and whether we participate in a global world, and tried to move into the new economy, or say let's put everything back in the tube and go backwards. that is a real divide you cannot explain away. there's a lot of things trump has said on the campaign trail that most republicans would stand up against. i think he talked about money and politics, and the role that place. -- plays. swing voters said, he can't be bought and sold. he is the person who buys and sells people. he is not bought and sold. having a government reform agenda that flies in the face of anything mitch mcconnell has ever stood for, that is a big
piece. if you look at his hire at proposals, he wants to give more generous loan fixes to students than obama did. he wants more money towards income-based repayment and loan .orgiveness than obama ever did that flies in the face of what republicans would want to see on the hill. he's also taken institutions on and said we have to do something we need toments, make it more worth the student'' money. that is something lamar alexander is not interested in. there are real interest -- issues past the aca. disagreements in the republican party. barry: again, this is literally versus seriously. he wo he knowshy who the voters are. n i'm sure there were not a whole lot of them that were. wrapped up in dark money. what they wanted was economic
growth. it's why they were -- elected barack obama. get us out of the war, and get us economic growth. they got neither. that surprises me, because that is not what donald trump was saying versus his opponent in the primary. if you wanted economic growth, you would have gone with marco rubio. barry: the data has been so clear on this. going back a decade. like trade, he actually is not anti-trade. but what voters do feel is it is not working for me. i will go back to nafta. this is a 30-year-old agreement that has never been updated. let'ss wrong with saying, get the three of us together. we know the things that are not working. we know that there are workers that are being displaced, we know that the tax system is not
allowing the free flow of capital the way it should, we know the regulatory environment is making it more difficult to trade, not easier. what is wrong with sitting down and figuring out, is there a better deal? most donald trump voters, knowing that donald trump is at the helm, are going to be perfectly fine with whatever he comes out with. is where the political and the media have got to understand. he is smarter than you think he is. he knows what the voters were looking for when they said change. adriel: before we go to q and a, we have two microphones set up. i will start with a question about the democrats. this election showed there was no real political penalty for obstructionism. senate republicans stood up obama's supreme court nominee, merrick garland, and nothing happened. it is in the democrats interest
to do the same. this is not their natural predilection, but should they? elaine: that is an interesting question, and i can't really answer that right now. i'm 99% sure that the democrats will be obstructionist of the things that matter a lot to them. so, all the rights issues. the issues of free choice for women. the democrats are going to fight pretty hard. they will filibuster, etc. there are probably things the democrats will agree on, the big one being infrastructure spending, because the unions, democrats and their friends in the unions, will benefit greatly from that. i think that they will fight with everything they've got on a lot of these issues. i think they will look forward that, and just see what kind willesident donald trump
be. i have to disagree with the notion that a presidential candidate goes out there for 11 months, and says very explicitly, and the voters don't really believe him. i don't buy that. it's a failure. he admits it. or lifting the bush era policies when it came to surveillance? that stuff? elaine: he did some of it. the fact is, one of his strengths in the election was that he was very clear, and very explicit. there was no subtlety. there was no nuance to any of his statements. why are his voters going to suddenly decide, he really didn't mean that? i don't buy it. ofhink he could have a year
their he disenchanted voters. barry: you read stories and the campaign that donald trump is inconsistent. last week he said this and this week he said that. it gets back to the literal versus serious. on the big issues where he was trying to speak to the economic anxieties, and security anxieties of the public, there wasn't any change in that. this is why to get back to the topic, what is the new president's agenda? we can all come up with 100 different things that we have a personal interest in, and we think is important. the challenge for the incoming administration like any incoming administration, you have a two-year. period to get important things in place. prioritizing them is critical. bill clinton made a mistake in
his first two years. barack obama made a mistake in his first two years. they were both punished for it by losing the congress. trump needs to know, and i think the people around him clearly understand this, focus on the things of why you got elected. it's not all these other ancillary issues that keeps washington busy. if he does it correctly, there would be democrats supporting this, not just to protect themselves, but because the issues about economic growth and security anxiety is something that cuts across all demographics. lanae: i think guantanamo is a great example. sometimes things you see in a campaign are much harder to actually do than they sound. that is what i hear a lot of 's agenda is. people had deep anxiety about how life would be and whether
place is in this system. i don't know that any of things or congressional republicans list of things is going to make these people feel any better. that is really the question. do they feel it at home? do they feel their economic anxieties are being alleviated? that he has done what he said and not forgotten them?when you look at what he was talking about doing on corporate tax reform, i'm not sure that the voters -- i'm not sure that delivers that. adriel: we have some questions with our remaining time. >> i wanted to talk for a second about criminal justice. there's a bipartisan criminal justice sentencing reform bill. it has some momentum, but it looks like it is not going to happen. in the meantime, the current administration is focused, even
before ferguson, about repairing the trust between police and the communities that they serve. trump's rhetoric has been very law and order heavy. how do you think that will play out, in terms of what he does in the first part of his administration? barry: that's actually part of the contract. i think the chances of getting a criminal justice reform bill that is closer to what has been discussed on the hill is pretty good, actually. who is in new york and has seen what works in the mayoral part and what has not worked. i'm pretty confident that is something that can get done in a bipartisan way. lanae: i hear a huge divide between where trump's on this and the people who have been negotiating on the hill are.
it's never been more clear at the convention, that he's running on a nixon version of what we need to do to fix the criminal justice system. that is not where mike lee and others are that has been negotiating this. sadly, i think in all justice reform is dead for now. there is not enough overlap willen how president trump see the world on the issue, and how some of the more evangelical folks looking at recidivism, and how do we integrate people in the community, want to see it handled. adriel: what else is on people's minds? about takingssion trump's policy proclamations literal is fascinating. but there's one issue in which he will have to literally deliver. that is bringing back manufacturing jobs to the midwest. that is where he won the election, right?
what's going to happen in 2018 and 2020, when it is dreadfully clear to people in the rust belt that manufacturing jobs are not coming back in the hundreds of thousands? a couple things. this gets to the first 100 days, and what you can get in place. it does take a while. the aca got put into place with promises you will keep your doctor, and costs will go down. it was, hold on, hold on. then you will see how it worked. ronald reagan faced this at the beginning of his administration. horrible economic situation, putting his regulatory and tax agenda in, he had to go out and convince the country, you have to give us time. if donald trump does what he do, what he's intending to which is to start moving in the regulatory environment, most
economic analysts will tell you that the regulatory burden of the past eight years has probably decreased gdp by a full point. if you just start that process, where ceos around the country can do the math and say, i don't have to put up with this nonsense anymore, and worker quality, and the stability of the u.s. economy gives me the incentive to be here rather than someplace else, you will start to see it. to you going to see returns the days of detroit and the auto capital of the world? no. there's also the sense, manufacturing has changed. this is where trump hit a nerve with people. we are not producing people into the workforce that is needed in manufacturing today. i think you will see that. elaine: i would take a
completely opposite view of that. you are not going to have detroit circa 1950, in 2018 or 2020. there are not hundreds of thousands of jobs to come back. we know that there has been some manufacturing coming back to the united states, and that's great. but guess who does it? robots. they are not creating those jobs, because when they bring the manufacturing back, it is all robotic base, that is why it is efficient and profitable. this is a giant lie that has been sold to people, and i think it is going to come back and bite them. robotics, is this immaculate conception? elaine: it's true. barry: somebody has to build them. create it doesn't thousands of jobs. lanae: those are advanced
manufacturing jobs that you need higher education for, and the people who trump promised everything you are the non-college-educated voters. elaine: we are not talking about hundreds of thousands of jobs and advanced manufacturing. the sad fact is advanced manufacturing simply does not employ, even if you have an educated workforce, it employs fewer people than old-fashioned manufacturing. it has been a lie. i think it is going to come back and people are going to be really unhappy. brian: we can argue over the economic theory, and we will see the numbers when they are there. we go through this cyclically, where we believe the supply side is going to bring growth, and then we think keynesian economics are going to bring growth, and then we think trade is going to bring growth. the numbers are the numbers, up.ever they end whether it happens, i don't know, but i do think we will bring more capital to the united
states. we will have a repatriation bill. the capital will come back and hopefully be spent somewhere. i think the bio and pharma worlds are in massive expansion and it would be great if they expanded here. i think university systems are sitting on a lot of patent trademarks and copyrights that they want to bring through fruition. the economy is ready to go. whether trump gets ready for it because it happened because of something he did, or because of something that obama did, i don't know. i think we will move a lot of legislation that is going to be helpful, not harmful. they may not jobs, be manufacturing jobs but there will be more. it's hard to have fewer than we have right now. he's going to get an opportunity jobs to america as an excuse to pass a whole bunch of bills, and we will just have to see if they work. on that note, i regretfully have to bring this spirited conversation to an end.
i want to thank my terrific panelists. thank you so much. [applause] >> next, our coverage from the daylong discussion on the incoming trump administration continues. this panel focuses on health care, and what changes we could expect when the president-elect takes office in january. >> thank you very much for joining us. we are blessed to have some very honored and distinguished guests here today. dr. mark mclennan is a former center for medicare and medicaid and the director, student and drug administration -- commissioner. run he worked for 20 years on capitol hill for a republican,
including charlie norwood and chuck grassley. seen a quite interesting election this year. it has a big impact on health policy. i would love for you to tell us a little bit about what you will be watching in the year ahead. can you start us off? >> i would be glad to. thank you for inviting me and having this panel. clearly, we are going to be seeing a lot of change. i think americans want to see a lot of change. one of the things we will all have to keep an eye on is to predatory -- and prioritize is what happens with coverage, and the first priority to not do any harm. what the affordable care act has it has brought 20 million people into coverage. it has done so without eroding the major source of coverage for
americans, which is employer-based insurance. as a result, we have the lowest uninsured rate that we've ever had since we have been collecting any data. nine out of 10 americans now have health care coverage. that is by anyone's measure, a good thing, not a bad thing. so as we move forward, thinking about what the changes might be for those individuals, as well as for the health-care providers, and the health-care industries that has been serving those individuals, and are receiving payments for the services, we have also seen a real positive impact on state budgets. of medicaid expansion in particular, in terms of ways in which it is really fast relieved. a lot of repercussions coming from the coverage of 20 million people that we will need to keep close watch on.
there's a desire by the new administration to repeal and replace obamacare, but what that replacement will do will be of critical importance. notably, we have vice president-elect pence to do medicaid expansion in his state.we had governor christie , who is head of the transition committee, who did medicaid expansion. speechaugust did a talking about the benefits, and what it has meant to people in new jersey and health-care providers in new jersey. first and foremost, we don't want to see backsliding, and i will be looking to see what happens around coverage. --ecca: just to pick mcclellan? >> this was quite an election that does have major implications. we will see exactly what the mandate terms out to be.
what i will be watching is the steps forward on modifying or repealing some of the major provisions that have been unpopular with the public, as well as other provisions in the law. i think it is how their replacement for the features of the affordable care act develops. a lot of the people who voted for the incoming republican and incoming president are people who would have been eligible or were eligible for coverage under the aca in one form or another. it has had some successes in increasing coverage. this a lot of dissatisfaction with the program as well. the people who are affected by it definitely need some new kinds of assistance.
lower income americans, including the ones who voted for the president-elect, just think that their health care challenges will go away, they are looking for a better alternative. as well as not -- what that might look like, it could be federal legislation, but i think there are a lot of instances in the republican congress for working more extensively with states to do more on the mental reforms, and the way assistance with health care coverage works to try and change the way the expectations around the delivery of care and health is in people's lives. there's a lot of back-and-forth with the state wanting to go farther and making it a program, about encouraging and supporting people to get back to work here . it's part of putting more emphasis on prevention, and
changing the way care was delivered. that is an important part of the steps forward as well. what are the replacement features, that can really drive changes in the ways that care works for lower income americans. i think there's a lot of room for improvement. in healthk at trends in this country over the last 20 evidence,ot of good we have seen significant improvements in life expectancy just like income, at the higher end of the distribution, but not ng working-class americans and many of the people who voted for this big change in federal leadership. and in some cases, for middle income, or lower middle income, and lower income whites, seeing in lifeote improvements
expectancy. things like opioid addiction, heart disease, cancer, that is going up. i don't think we have the solution yet to help those individuals get a better life. it does include -- improve things like increasing income, better jobs, and rethinking the way traditional medicaid coverage has worked. we will be looking for steps like that, and finally, there was a lot of interest in the congress taking new steps to promoting that are and more effective innovation, whether it was around finding cures for cancer are making the development process for drugs and medical devices, and support for positive changes. that's also something to look for in the weeks ahead. >> i think one of the important places to start first is to move beyond what