BlogHers Talk Health Care with Speaker of the House Nancy Pelosi (AUDIO)
By Erin Kotecki Vest on October 16, 2009
BlogHer Original Post
Speaker of the House Nancy Pelosi joined BlogHers for a health care reform discussion where she tackled many questions on women and health care.
The Speaker spent 30 minutes answering questions from maternity care to middle class tax implications from a variety of women bloggers.
You can listen to the call with Speaker Pelosi -
Or you can read the transcript of the call -
Nancy Watzmen: Hi. Welcome everyone. I’m Nancy Watsmen of the Sunlight Foundation representing Blogher today in their community journalism initiative on healthcare policy.
The Sunlight Foundation is a non-partisan, non-profit dedicated to using the power of the Internet to catalyze greater government openness and transparencies.
As CEO (Lisa Stone) announced, Blogher is sponsoring the bi-partisan series of telephone conference calls to connect women bloggers directly with legislators.
Today on the call we have House Speaker, Nancy Pelosi, who as you all know is right in the thick of the healthcare debate and we’ll turn the call over to her for an introduction and then I know lots of people have question so we’ll get right to them. Speaker Pelosi.
Nancy Pelosi: Thank you very much Nancy and thanks for the opportunity to share some thoughts about healthcare reform especially how the impact - how it impacts women on this call today.
We are very enthusiastic about where we are on this legislation this week. The Senate and Finance Committee passed its bill out, now five committees have. We are closer to having health insurance reform as we ever have been in our history.
And it is from the standpoint of the House of Representatives which I speak for in terms of our initiative, our principals our that we will have affordability for the middle class and we will have security for America’s seniors and we will have responsibility to our children to make this bill very fiscally sound. And it doesn’t add a dime to the deficit.
When it comes to women in particular, women have the most to gain in health insurance reform in my view. Women often face higher health care costs in men and face multiple other barriers to obtaining health insurance, for example, women are charged up to 48% more then men in the individual market.
In our bill it would make it illegal for insurance companies to use gender ratings, charging women more then men for the same coverage. In addition, women are denied coverage or charged more for preexisting conditions like pregnancy, C-Sections or domestic violence.
If you’ve ever been in any of those situation and of course we - our bill makes it against the law for (unintelligible) who are denied coverage or charged higher premiums on the basis or preexisting conditions.
Just a couple more things - 79% of women with individual market policies do not have any maternity coverage. Imagine that. In our legislation exchange would be required to cover maternity services and over time plans outside the exchange would be required to do so as well.
Again, many women do not have access to employer-provided coverage. This will be changed in the bill because premium assistance would be provided to all those with an income up to 400% of poverty which is about for a couple about 80-some thousand dollars or 40-some for an individual.
Even employer-provided coverage is in decline and so we’re trying to change that dynamic as well. And women’s (health) face more unaffordable out-of-pocket costs and preventative services are also often unaffordable to women and their children. And the legislation changes that. And it just would - putting on this opening, just relate to the economy.
Over one million women have lost health insurance coverage due to their spouse’s job loss and they also then because of their own job loss when the women are in the market - are working - are some of the first people to be let go and therefore lose their health insurance.
So it is important for us to have health insurance that expands coverage for all. It does - do it in a way that improves the quality, lowers the cost and enables people to keep what they have if they like it but also to recognize the disparities that exist for women and health care.
Pleased to take any questions and again I thank you Nancy for the opportunity to share some thoughts on our legislation.
Nancy Watzmen: Well thank you. Yes, let’s go straight to the first caller.
Operator: Ladies and gentlemen if you would like to register a question, please press the 1 followed by the 4 on your telephone. You will hear a three-toned prompt to acknowledge your request. If your question has been answered and you’d like to withdraw, please press the 1 followed by the 3.
If you’re using a speakerphone, please lift your handset before entering your request. Our first question comes from the line of R726. Please go ahead.
Woman: Good morning Madame Speaker. Thank you so much.
Nancy Pelosi: Good morning.
(Audrey): Thank you so much for taking time to speak with us today and listen to our concerns. My name is (Audrey) and I’m joining in from Maine. Briefly, my chronic illness is such that my family is in financial ruin now and facing foreclosure due to the result of medical bills. We do have health insurance but are faced with an insane deductible and outrageous co pays that have led us to choose between our family’s one piece of security, our home, or our mental and physical health.
I’ve been fortunate enough to sit down on two recent conference calls with the elected representatives of both parties and neither have been able to answer my question in a way that is meaningful to me or my family. Right now especially we’re all hearing very different and sometimes alarming things from people on both side of the health care reform challenge.
And most recently it’s been claimed that the proposal that passed the senate finance committee would indeed sharply raise our family’s premiums. Very simply, Madame Speaker, can you tell me why I should lend my voice and support to the proposed health care reform when I cannot clearly find out what it means for me and hundreds of thousands of families like mine, whether it means more of the same or genuine relief from being pimped out to the insurance companies for profit?
Nancy Pelosi: Thank you (Audrey) for your question. Let me just - I don’t want to speak to what’s in the senate bill because we think our bill is much better then the senate bill but let me give you some hope as to what is on our side and what we will go to the conference table to fight for and I believe we’ll prevail on.
It - I want to just put it in the conte- a little bigger context for a moment. But this - these insurance reforms, and they will include those that address your situation, are essential to how we go forward. No discrimination for preexisting conditions like diabetes, a heart condition or cancer. These are - all that I named are long term illnesses or chronic conditions.
No dropping your coverage because you become sick. No refusal to renew your coverage if you’ve paid in full and become ill. No more job loss or life decisions made based on loss of coverage. No need to change doctors or plans if you like the coverage you have.
Now here are the ones that - no co pays for preventive and wellness care. Now in your case, no excessive out-of-pocket expenses, deductibles or co pays. Yearly caps on what you pay. Yearly caps on what you pay. No yearly or lifetime cost caps on what insurance companies cover.
Now from what you have said it sounds to me like you have high deductible and out of pocket and that would be excluded. No excessive out-of-pocket expenses, deductibles or co pays because that makes it unaffordable therefore unaccessible (sic) - inaccessible to people.
And again, if - say - I know this is probably not your situation, but for someone who has - a person with a disability which is - would be similar to having a chronic disease ill- condition. I won’t say disease. You would have a cap on what you pay in but no yearly or lifetime cap on what your insurance companies cover.
So you would be protected in that way. And your case is one of the main reasons why we - the current system is totally unsustainable for America’s working families. The economic security that is undermined by high medical costs, you know, is related to your physical condition.
I like when you’ve been diagnosed with cancer now you’re going to - you have a high deductible and by the way, lessen the stress in your life. Well, that’s impossible, right? So the high co pay and the high deductible is what we are trying to get at in this bill.
And that’s why I said is our first principle - affordability for the middle class. That doesn’t just mean affordability for standard fare and while everyone’s well, your insurance doesn’t cost that much. It means affordability when you are well and affordability when you are sick.
Sixty percent of the bankruptcies last year in our country were due to medical bills. So the relationship between health care costs and economic security are directly related as you have spelled out so clearly. But stay tuned to what you see because this is going to be a fight that we intend to win as we go forward.
And one of the - if I just may go from (Audrey)’s question to another reason why we believe we will be able to keep this promise, is first of all it - everything has to fit together. The insurance companies must - that reform must take place.
And it must take place within the - what we call the exchange. Now there will be an exchange in which people can go buy insurance or if they’re under 400% of poverty would be sub - get some subsidy relative to their income level to help them afford the insurance.
And if - what we’re saying though is you must do this. You are mandated to do this and in our health bill, businesses are mandated to provide the insurance. So I am saying as Speaker, how can we mandate people to go buy and charge from the very same people who have in some respects ripped them off up until now.
So what we’re saying is we will help with subsidies. We’re making it affordable by having within the exchange a public option. So that says to (Audrey), if you - if we can help you with your health - to afford your health insurance, and we mandate that you buy it, but we can’t - we do not want you to be forced to buy it from the same people who didn’t give you a fair shake to begin with, you can do that if you wish. If it works for you - or it didn’t work for you but it worked for somebody, but we all - rather then force people to buy from the insurance industry, we want to give them the freedom to buy in the public option or in the insurance industry - whichever they please, but they would have the freedom to make that choice.
It would give them leverage. It would increase competition and we believe, lower costs and keep the insurance companies on it.
Nancy Watzmen: Thanks so much Speaker. I know we have a lot of questions so let’s go to the next...
Nancy Pelosi: Thank you (Audrey). Good luck to you.
(Audrey): Thank you.
Nancy Pelosi: Pay attention to what we’re doing. Hold us accountable.
Operator: And our next question is from the line of R738. Please proceed with your question.
(Emily): Hi Madame Speaker. It’s really an honor to talk to you today. My name is...
Nancy Pelosi: My pleasure. Thank you.
(Emily): My name is (Emily) and I’m a blogger from Chicago, Illinois. Right now I’m actually sitting in the DMV so this is very convenient that I have the opportunity to ask you this question.
As a (unintelligible) it kind of strikes fear in my heart to think that the government might be overseeing health care. It’s scary enough when I have to go to the post office and the DMV and see the level or bureaucracy that I have to deal with just to get something simple like renew my driver’s license.
I know that you said there will be a public option and there will be government oversight, so my question for you is why lend my voice to support of the house bill knowing that the government may be responsible for doling out healthcare and overseeing something that is very important and vital to me.
Nancy Pelosi: Well make - let me make it a different - a distinction here. We are not doling out healthcare. What we are doing is helping people pay for the healthcare having a level playing field for the public so they can do it. Now an example, which you may not like but has been successful and works for millions - tens of millions of people in our country is Medicare.
And frequently when people come to the meetings and say, “I don’t want any government initiative, and by the way, keep your hands off my Medicare,” is one of the contradictions that we run into. But your questioning of the efficiency of government is one that I respect.
In fact, in our legislation how we’re able to cover the costs is by injecting - just injecting very harsh scrutiny to the system and injecting efficiencies into it so that we can extract some of the resources out of it without impacting the benefits but addressing waste, fraud, abuse, duplication, obsolescence and the like.
And that should’ve been done a while ago and we’ve tried to do that over time and this gives us the opportunity to do it. But the public option is perhaps ill named because it sounds like it’s a public option.
What it is is an option that must compete with a level playing field with a private sector that any - it must be administratively sustainable on its own. It has to pay for itself and it has to be actuarially sound so it can’t have any advantage over the private sector.
The advantage it does have is that its profit motive may be different in terms of - and I’ll go into that in a second and it would probably not be advertising to the extent the health insurance companies do.
But did you know that right now health insurance companies can spend what it - they take in the premiums and they can spend whatever they want on benefits? Well in our bill we insist that the health insurance companies spend 85% of what they take in in premiums in - to spend on benefits.
That’s what insurance is about. You pool resources for when you need them rather then you pool them so they can be excessive profits and compensation and advertising budgets and the rest. But the money really does - largely 85% of it to them.
So it is not to be confused with any delivery of service - of health care services and that’s how sometimes people like to paint it. That’s not what it’s about. It’s to create a level playing field for private sector competition for market oriented solutions so that the middle income families in America have a chance.
And I might say that in addition to what I just said about the affordability of insurance, in the bill you would be pleased to note that there are many initiatives through public private partnerships for innovation, for incentives to the private sector on its own in terms of health IT and the - using the technologies to go forward to again recognize where the market solutions can work better.
So it is - again everything that we try to do now is in the tradition of our founders which were very entrepreneurial, very market oriented and we’re public private partnerships we the preferred way rather then a public solution.
Nancy Wazsmen: Okay next question.
Operator: Our next question is from the line of R772. Please go ahead with your question.
(Heather): Good morning Madame Speaker. Thank you so much for the opportunity to talk with you.
Nancy Pelosi: Good morning. Thank you.
(Heather): My name is (Heather) and I’m from Los Angeles, California.
Nancy Pelosi: Good morning.
(Heather): And my question for you is - good morning - my question for you is there’s a lot of talk about the preexisting condition exclusions but I’m worried that things are going to get a little nitpicky. For example, I have a blood clotting condition that makes my pregnancies extremely high risk and runs the risk of premature birth for my children.
Everyone involved in my medical care, from my doctors all the way up to my insurance companies know that my pregnancies are going to cost more. And so I’m worried that this preexisting condition clause is not going to be across the board, if it’s going to end up being gray area because my preexisting condition is an active one. It’s not for a lack of a better example, cancer that could be in remission. And is this going to be something that might end up happening?
Nancy Pelosi: No, no (Heather). Actually quite to the contrary because what we are saying very clearly is there can be no discrimination in cost, that is to say, what is charged to an individual for - because of a preexisting condition.
It doesn’t same some, not others, and the rest. And the insurance industry will say, “Well then it’s going to cost us so much more money to insure all these people.”
Nancy Pelosi: And that’s why we are saying that the more - if we have this big pool of people and we can do it. Let me just say in terms of maternity services in particular, as a benefit category in an essential ben- in other words, we have an essential benefit package that we’re insisting upon and in the bill it includes coverage of maternity services as a benefit category in the essential benefit package that is outlined.
As a result all health insurance plans in the health insurance exchange would be required to cover all maternity services and over time even the plans that are not in the exchange. If a plan said, “I’m not going to go into the exchange,” they would even be required to do so.
So when the plan comes into effect, you would choose a plan and many of which would exist within the exchange, to cover all medical benefits right from the start. And the insurance companies want to operate within the exchange. They want to because that’s where a good deal - you know, they’re going to get tens of millions more customers and most of those will be within the exchange.
So they want to operate within the exchange. There’s no disincentive. There’s no incentive, shall I say, for them to operate outside and your situation is exactly - we’re not just talking - they’re - whether it’s C section or, you know, other extenuating circumstances occurring associated with pregnancy, pregnancy and all of its - and all that that implies cannot be considered a preexisting condition. It is now as is can you believe, domestic violence?
Nancy Pelosi: C section. They’re called preexisting conditions. I’ve had children and they told me I was a poor risk. I mean, this is many years ago when I was having babies. They said, “You’re a poor risk.” I said, “I thought I proved my strength by having five babies.” And they said, “Now we don’t want to give you any insurance because you’ve had five children.”
Nancy Watzmen: Well as a pregnant person myself I appreciate the discussion about all that. Let’s go on to the next call.
Nancy Pelosi: Okay.
Operator: Our next question is from the line of R768. Please go ahead. The line of R768, please ask your question. Your line is open.
Nancy Watzmen: Do we have the next caller? Let’s move on.
Nancy Pelosi: As you get the next caller, I want to thank - wish Heather (lock later) family and so (Audrey) with her situation and (Emily). Keep watching what we’re doing. Hold us accountable as I said to (Audrey) earlier.
Nancy Wazsmen: That’s what we’re here for. Okay, do we have the next caller?
Nancy Watzmen: I know we don’t have much time, so.
Operator: It is from the line of R764. Please so ahead.
(Dana Loesch): Hi Madam Speaker. My name is (Dana Loesch). I’m calling from St. Louis. And I guess the question that I have for you - and I do appreciate the time that you’re taking this morning to speak with all of us.
Nancy Pelosi: My pleasure.
(Dana Loesch): My question for you is you were talking about how to protect seniors, talking about how to protect middle class families and I’m kind of concerned twofold. I’m concerned, one, about this insurance exchange but I’m also wondering how there can be any claims made to protect the middle class when our President himself said in past June and then ABC news, he said he wants to cut $200 billion from Medicare and Medicaid spending over the next decade to help pay for this healthcare system.
And I know that a lot of things have been said to the contrary of this but I’m just wondering how you reconcile what he has said about cutting Medicare and Medicaid, how you can reconcile the latest report that came out that said that this plan is actually going to cost middle class families and additional $1700 per year. And how that can also be reconciled with - when we talk about the insurance exchange.
The (Pace) and Choice Act was actually going to take employer subsidies and - for health care - give those to the employees so they could go out and buy their own insurance and have that power themselves instead of having to rely on the government to do it for them in the exchange.
And I know it’s kind of a three-parter but those three things are all concerning me equally.
Nancy Pelosi: Well let’s start with Medicare because I believe that’s where you started.
(Dana Loesch): Yes.
Nancy Pelosi: And that is that yes, the President said $200 billion. It’ll probably be more then that over ten years because we do see that there is opportunity to wring out waste, fraud, abuse, obsolescence and duplication. We’ve tried to do this before. Now we’re in the position of power. All that we can do so without any diminution of benefit in the initiative.
And that is why we - Medicare solvency will be extended by another five years under the house bill because we make Medicare sustainable. That is why AARP has said that in opposition to a ad campaign that the health insurance industry has put out there to say it’s going to hurt seniors.
Their charge is the industry has said that it would hurt America’s seniors yet the AARP has said the change is actually aimed to strengthen Medicare and improve beneficiary’s care and access to physicians. They’re not the only ones saying it but since their brand name is so big I quote them. But other - fact check and others have confirmed that statement as well because that is what the intention is.
Look, we passed Medicare to begin with 44 years ago this summer. It was a Democratic initiative, had some bipartisan support. We hope this legislation will. We always strive for that but this is an initiative that we have a commitment to from its birth and that it keeps its promise to our seniors. So do not interpret that there will be efficiencies thrust upon it to mean that it would weaken instead it strengthens Medicare.
In terms of the exchange, exchange is really quite a brilliant initiative to say that in the exchange were the insurance companies want to participate that they will be - people will be able to go into an exchange if they’re below 44 - 400% of poverty they would get some assistance depending on how far below they are to - for purchasing an exchange.
The businesses would have tax credits, small businesses, so that their employees can go into the exchange. And also others can be in the exchange. And that’s why we say the (unintelligible) arena, the insurance industry, it has to be an arena that also gives the freedom of individuals to have another option which is a not-for-profit option there.
So it is - it’s brilliant but again, when we finish our bill, which should be within a week and people see it on the Internet and how one part of it relates to another I think they will see the brilliance of the exchange.
What was your third point (Dana)?
(Dana Loesch): I asked about the - I wanted to do a quick - can I do a quick follow up? Will anybody object if I...
Nancy Pelosi: ...what the third one is so I can incorporate into the answer.
(Dana Loesch): Okay. No, I had asked about the Medicare and then the insurance exchange and then I mentioned how the Patient’s Choice Act was actually taking - their idea was to take federal subsidies that employer - for employers for health care, and have the employees use that to go out and buy their own health care instead of having sort of the - instead of having a government involved in with the exchange. And I was wondering what you had you had thought of that.
Nancy Pelosi: Okay and so you wanted to have a call back on the Medicare, did you? You said you wanted to...
(Dana Loesch): No that was the third part of my - that was kind of like the third end of the question was that.
Nancy Pelosi: Oh okay but I thought you said may I say something about what you already...
(Dana Loesch): Oh no. I know we’re running out of time and there’re other people waiting so go ahead.
Nancy Pelosi: No, I think this is probably going to be the last question on that. But again, the way this has been put together it has an integrity to it and this would have - it would have the benefit of having employers or individuals in a market so that it would be a situation where the cost would be lower for all.
And let me just say that - because I think it’s important to note in relationship to your question and just the whole insurance reform - if we do nothing, small businesses will have an increased cost of $2.5 trillion over the next ten years - $2.5 trillion.
It’s just totally unsustainable. The insurance industry as I mentioned has said they’re going to increase the premiums to small businesses, to businesses by 10% next year - 10%. And for individual families it will go up by thousands of dollars and over ten years be something like nearly $20,000 in increase premiums.
So the status quo is totally unacceptable. But when you put together an initiative that is real reform that says the insurance companies must have their reforms, there must be an exchange in which people can have leverage, whether they’re a small business, people will take credits from small businesses that are excluded from requiring that they have health insurance because they are so small, or whether you are below 400% of poverty or if you’re above it - that there is a place that is a level playing field for the middle class.
So when I send my conferees to the table from the house to the senate, I want them to have the most muscle for the middle class. I want a bill that goes right down the middle, that does not add a dime to the deficit, goes down the middle philosophically so that it really does the job. It’s not some philosophical idea that somebody had.
It’s a very pragmatic system to provide the health insurance so that our economy - our - it helps individuals in terms of their costs, it helps businesses in terms of their cost, it helps the economy in terms of the dynamism that our businesses would not be - have a stranglehold on them, increases their competitiveness especially internationally, and it also helps reduce the deficit.
Health insurance reform is entitlement reform and that’s what we have to have to take down the deficit. So this is - again, the status quo is totally unsustainable and unacceptable. The course the we are going on saves the most for the individual for the business and for the government and the taxpayer and is something that will make America healthier.
It’s not just about health care. It’s about health - that prevention. It’s about wellness. It’s about early intervention. It’s about biomedical research and the issue of customized private - personalized care that is specific to an individual. It is about health IT so that the health care is onsite. Wherever somebody is their records are there and so it makes it...
Nancy Watzmen: Excuse me Speaker - we’re being told by your staff that you have to get on a plane.
Nancy Pelosi: Yes, unfortunately I do so...
Nancy Watzmen: With the President.
Nancy Pelosi: I’m going to have to say goodbye for now and hopefully we can get together again especially when our bill is finally - is up on the Internet which should be in about a week or two depending on how we dissolve some of the outstanding issues. But whenever it is, before we take it up on the floor, the public will have a num- 72 hours at a minimum to see what is up there.
But in the meantime we want to give people an idea of what is there so it - when they see the final bill it’s just in some of the clarifications but not a complete introduction to a whole new idea.
So thank you Nancy very much. Good luck to all of you and I look forward to having another conversation sometime soon.
Nancy Watzmen: That’s great. Thanks so much.
Nancy Pelosi: Thank you.
Nancy Watzmen: And that wraps up today’s call with House Speaker Nancy Pelosi and blog her. Thanks for participating and thanks bloggers for joining us.
Please keep on eye on blogher.com for the audio and transcript of this call and for the announcement of the next call where we’ll give you another opportunity to talk about health care reform with legislators.
Operator intro and outro has been removed
Join us for our next call in our bi-partisan series on Wednesday October 21st, with Senator Jeff Merkley from Oregon.
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