President Obama and President Clinton Discuss Health Care


– Ladies and gentlemen,
please welcome former Secretary of State
of the United States, Hillary Rodham Clinton. [applause]>>Mrs. Clinton:
Good afternoon, everyone. [applause] Well, thank you. Thank you very much. I have the great pleasure to
introduce our next two speakers, who are about to
have a conversation concerning health care. And I thought hard about how
to introduce these two men. [laughter] And the more
I thought about it, the more I realized
how much they have in common. They are both left-handed. [laughter] They both love golf, a game that does not
often reciprocate the love they put into it. [laughter] They both are
fanatic sports fans and go to great lengths
to be in front of the TV or on the side of
the court or the field. They both are
master politicians. Each of them has only
lost one election. [laughter] They are both Democrats. They have fabulous daughters. [laughter] They each married
far above themselves. [laughter and applause] And they each
love our country. And so please
join me in welcoming Number 42 and Number 44, Bill Clinton
and President Barack Obama. [applause]>>President Obama:
Mr. President. [laughter]>>President Clinton:
Are you interviewing me?>>President Obama:
That would be bad. I’ve been talking a lot today.>>President Clinton:
I want to thank you
for giving Hillary a job. That was a good thing you did. [laughter] Thank you for coming.>>President Obama:
Well, it is wonderful
to be back. And let me start just
by saying to all the people who have for years now supported
the incredible efforts of CGI, thank you. Because wherever we travel,
all across the globe, we see the impact that
it’s making every single day. And we’re very proud
of what you all do. And let me say
that we still miss our former Secretary of State. [applause] And I should add that
there’s nothing she said that was not true, particularly the part
about us marrying up. [laughter]>>President Clinton:
Well, that brings me to
my first health care comment. This is going to be a
conversation about domestic and international health,
and America’s role in it. But I want to
begin by telling you that I think the First Lady
has done a great job in this fight against
childhood obesity. We have been honored
at our foundation to be asked to represent
her effort in 18,000 schools where we’ve lowered
the calories in drinks being served in
schools by 90 percent. But she has been
great on that one. The other thing I think is
that I was a little upset — and, as you know, called one
of your administration members when you got to Africa — when I read an article
that said that you didn’t have a big initiative in Africa. And I said — I can’t say
exactly what I said — [laughter] — but I said
that is inaccurate. [laughter] That’s the sanitized
version of what I said. [laughter] Because when the President
took office, our program, begun under
President Bush, PEPFAR, was giving antiretroviral
medicine to 1.7 million people. Because of an agreement that
I made with President Bush to use generic drugs that
were approved by the FDA, about half our drugs were
being purchased in that way. Under President Obama,
we’ve gone to 99 percent. We are treating more
than 5.1 million, three times as many
for less money. [applause] That is a stunning legacy — so that more money has been put
into malaria medicine, bed nets, so you saved a lot of money and
saved more lives while doing it. And I’m very proud of that. And I want to thank you for it. It’s important. [applause] Now, maybe at the end of this
conversation we can get back to some of your current
global health initiatives. But let’s talk a little
about the health care law, because we’re about
to begin on October 1st open enrollment for six months. And I’d like to give you
a chance, first of all, to tell them why —
when you took office, we were teetering on
the brink of a depression. You had to avert it. You had to start
the recovery again. Why in the midst
of all this grief did you also take on
this complex issue? Many people were saying,
why doesn’t he just focus on the economy
and leave this alone? So tell us why you did it.>>President Obama:
Well, first of all, I think it’s
important to remember that health care is the economy. A massive part of our economy. And so the idea that somehow
we can separate out the two is a fallacy. Second of all,
the effort for us to deal with a
multifaceted health care crisis has been going on for decades. And the person who just
introduced us, as well as you, early in your presidency,
had as much to do with helping to shape the
conversation as anybody. The fact is that we have
been, up until recently, the only advanced
industrialized nation on Earth that permits large
numbers of its people to languish without
health insurance. Not only is there
the cruelty of people who are unable
to get health insurance having to use the emergency
room as their doctor or their health service, but — we’re also more efficient
than anybody else and so when we talk about,
for example, our deficit — you know this better
than anybody — the reason that we have
not only current deficits but also projected
long-term deficits — the structural deficit that
we have is primarily based on the fact that we
have a hugely inefficient, wildly expensive
health care system that does not produce
better outcomes. And if we spent the same amount
of money on health care that Canada or France
or Great Britain did, or Japan, or any other
industrialized country, with the same outcomes
or better outcomes, that essentially would remove
our structural deficit, which would then free up
dollars for us to invest in early-childhood education
and infrastructure and medical research
and all the other things that can make sure
that we’re competitive and growing rapidly
over the long term. So my view when
I came into office was we’ve got
an immediate crisis — we’ve got to get
the economy growing. But what we
also have to do is to start tackling some
of these structural problems that had been
building up for years. And one of the biggest
structural problems was health care. It’s what accounts
for our deficit. It’s what accounts for our debt. It causes pain and misery
to millions of people all across the country. It is a huge burden
on our businesses. I was out at a Ford
plant out in Missouri, making the F series out there, and this is
a big stamping plant. Ford is now the biggest
seller in the United States. We took that lead back
from the Japanese automakers. But we are still
burdened by the fact that every U.S. automobile
that is manufactured requires a couple of thousand dollars
in added health care costs that our foreign
competitors don’t have to pay. So this has everything
to do with the economy, in addition to what I consider
to be the moral imperative that a mom should not
have to go bankrupt if her son or
daughter gets sick; that a family who’s
dealing with a layoff and is already struggling
to pay the bills shouldn’t also be wondering whether they’re one illness
away from losing their home. And I think most
Americans agree with that. [applause]>>President Clinton:
So first of all, folks, for those of you who
are from the United States, that’s about as good an overview
as you’re ever going to hear of what this economic issue is. But you remember the President
said our structural deficit would disappear if we had a
comparable health care system in terms of cost
to the French and Germans that are consistently
rated the highest. It’s about
a trillion dollars a year, and somewhere around
44 percent of that money is government-funded money. So you just run the numbers. Think — over half of our
deficit has already disappeared because of economic growth and the revenues you raised
and the spending we cut. And you pretty much
get rid of the rest of it if we just had
a comparably expensive system to any other country. Before you took office, we lost a car company that
wanted to locate in Michigan that went instead to Canada, and they announced —
they said, look, we’re a car company that
provides health care benefits to an employee;
were not a health care company that sells cars
to cover our bills. We have to go to Canada. And it was one of
the few companies willing to go on
record and say this. So thank you for doing it. So let’s talk about this. What does this open
enrollment mean? How are people going
to get involved? When you have universal
enrollment you can manage your costs better
and cut inflation down. I’ll give the President
a chance to talk about all the good
stuff that’s happened, but I just want you
to know one thing. In the last three years,
just as we started doing this, inflation in health care costs
has dropped to 4 percent for three years in a row for
the first time in 50 years. Fifty years. [applause] Before that,
the costs were going up at three times the rate
of inflation for a decade. So now what? What are you going
to do on October 1st? Tell them how this
has got to work.>>President Obama:
Well, let me give folks just
a little bit of background about what’s already in place and then what happens
on October 1st. When we passed the
Affordable Care Act, there were a number
of components to it. A big part of it
was essentially providing a Patient’s Bill of Rights
that Americans and advocates have been fighting
for for decades. So what we wanted
to do was make sure if you already have
health insurance that you get a fair deal, that you’re being treated
well by your insurers. So we eliminated, prohibited insurance companies
from imposing lifetime limits, which oftentimes if
a family member really got sick, they thought they were covered until suddenly
they hit that limit and now they’re out
hundreds of thousands of dollars with no way of paying. We said to insurance companies, you’ve got to use at least
80 percent of your premium that you’re receiving
on actual health care — not on administrative
costs and CEO bonuses. And if you don’t,
you’ve got to rebate anything that you spent
back to the consumer. So there are
millions of Americans who’ve received rebates. They may not know
that they got it because of
the Affordable Care Act — or “Obamacare” — but they’re pretty happy
to get those rebates back, because it made sure
that the insurance companies were treating folks fairly. We said that any young person who doesn’t have
health insurance can stay on their
parent’s health insurance until they’re 26 years old. And as a consequence,
what we’ve seen is steadily the rate
of uninsured for young people dropping over the last three
years since the bill passed and obviously providing
a lot of relief to a lot of parents out there because a lot of young
people, as they’ve been entering into the job market at a
time when jobs are tough to get and oftentimes
benefits are slim, this is providing
enormous security until they get
more firmly established in the labor market. We provided additional discounts
for prescription drugs for seniors
under the Medicare program. And so seniors have
saved billions of dollars when it comes to their
prescription drugs. So there have been
over the last three years a whole array
of consumer protections and savings for consumers that result directly
from the law that we passed. And for those who say that
they want to repeal it, typically when
you ask them about, what are all these various
benefits, they say, well, that one is good, and
that one is pretty good, and we’d keep that. And you pretty much
go down the list, and there’s not too
much people object to. You will recall also at
the time that part of the way that we paid
for the health care bill was we said Medicare
is wasting a lot of money without making
seniors healthier. And there was
a lot of hue and cry about how we were
taking money out of Medicare — well, it turns out
that we were right, that we could change how doctors
and hospitals and providers were operating,
rewarding them for outcomes, as opposed to simply how many
procedures that they did. You started seeing
practices change among millions
of providers across the country. Medicare rates have actually
slowed in terms of inflation. Seniors have saved money. Folks are healthier. And some of those savings we’ve
been able to use to make sure that people who don’t
have health insurance get health insurance. Now, this brings
me to October 1st. The one part
of the Affordable Care Act that required several
years to set up, but a critical part, was how do we provide health
insurance for individuals who don’t get health
insurance through the job? It’s a historical accident that
in this country health care is attached to employers. And part of the problem
is if you’re out there shopping for health
insurance on your own, you’re not part of a big pool, well, there’s no aggregation
of risk taking place for the insurers. So they’re basically
going to say, let’s see, you’re 50 years old. You got high blood pressure. And we just look at
the actuarial tables and we figure you’re
going to get sick, so we’re going
to charge you $1,500 a month for health insurance, which the average person
has no way of affording — because there’s
no pooling of risk. So what we said was we need
to set up a mechanism to pool people who currently
don’t have health insurance so that they have
the same purchasing power, the same leverage
that a big companies does when they’re negotiating
with the insurance company. And essentially what
we’ve done is we’ve created what we’re calling
marketplaces in every state across the country
where consumers are now able to be part of a big pool. Insurers
have to bid, essentially compete for the business of that pool. And what we now have set
up are these marketplaces that provide high-quality health
care at affordable prices, giving people choices
so that they can get the health insurance
that they need and they want. And the premiums are
significantly lower than what they were
able to previously get. I’ll take the example
of New York State. The insurers
put in their bids to participate in
these marketplaces. It turns out that their rates
are up to 50 percent lower than what was
available previously if you just went
on the open market and you tried to get
health insurance. [applause] Fifty percent lower
in this state. California —
it’s about 33 percent lower. In my home state of Illinois, they just announced
it’s about 25 percent lower. So just by pooling
and creating competition so that insurers have
to go after people’s business the way they go
after a group plan, we have drastically
reduced premiums and costs. On top of that, what we’re now
doing is we’re saying if with the better deal that you
got you still can’t afford it, we’re going to give you tax
credits to essentially subsidize your purchase of
health insurance. And here’s the net result. We’ll be continuing to roll
out what the actual prices are going to end up being, but I can tell you
right now that in many states across the country,
if you’re, say, a 27-year-old young woman,
don’t have health insurance, you get on that exchange, you’re going to
be able to purchase high-quality health insurance for less than
the cost of your cellphone bill. And because all the insurers
who participate are required to, for example, provide
free preventive care, free contraceptive
care, that young woman, she may make up what
she’s spending on premiums just on her monthly
use of health care. So this is going
to be a good deal for those who don’t
have health insurance. Those who already
have health insurance get better health insurance. And the best part of
the whole thing is, because of these changes
we initiated in terms of how we’re paying providers,
health care costs have grown, as you pointed out,
Mr. President, at the slowest rate in 50 years. We are bending the cost curve
and getting at the problems that are creating our deficits
in Medicare and Medicaid. [applause]>>President Clinton:
I should point out that,
so far, in most states, one of the good things that at least I didn’t
know whether it would happen is when we began
this in the United States, more than 80 percent of
the American states had only one or two companies
providing health insurance who had more than
80 percent of the market. So there was, in effect,
no price competition. So what I was terrified
of was we’d open these things and there would only be one
company show up and bid, and this whole thing, we’d be
having an academic conversation. Instead, it’s actually led
to the establishment of more companies
doing more bidding. And I think part of it is they
have greater confidence that they can deliver health
care at a more modest cost. So, so far, it’s good. But I think it’s important
for you to the tell the people why we’re doing
all this outreach — because this only works, for example,
if young people show up. And even if they buy
their cheapest plan, then they claim
their tax credits, so it won’t cost them
much — 100 bucks a month or so. We got to have
them in the pools, because otherwise all these
projected low costs cannot be held if older people
with preexisting conditions are
disproportionately represented in any given state. You’ve got to have
everybody lined up. So explain what kind of — all the work you’ve
been doing on the outreach for the opening on October.>>President Obama:
I think President Clinton
makes a really important point. And the way pools
work, any pool, is essentially those of us
who are healthy subsidize somebody who is sick
at any given time. We do that because
we anticipate, well, at some point we’ll get sick
and hope the healthy person is in our pool so those costs
and those risks get spread. That’s what insurance
is all about. And what happens is
if you don’t have pools that are
a cross-section of society, then people who
are already sick or more likely to get sick, they’ll
all rush out and buy insurance. People who are healthy,
they say, you know what, I won’t bother. And you get what’s
called adverse selection. Essentially what happens
is that the premiums start going higher and higher
because the risks aren’t spread broadly enough
across the population. So you want to get a good
cross-section in every pool. That’s why big companies
have an easier time getting good rates for their
employees than small companies, because if you only have
five employees and one person is stricken with
breast cancer, let’s say, your rates potentially shoot up. But if it’s a
thousand employees, then it gets spread out. So on October 1st,
open enrollment begins. All these folks can start
signing up for the marketplace. And what we want to make
sure of is that everybody, in every category,
in every age group, understands why health
insurance is important, understands why
they should sign up, understands the choices that are
going to be available to them. They’re going to be able
to go to a computer, tap on the web page and they’re
going to be able to shop just like you shopped
for an airline ticket or a flat-screen TV, and see what’s the
best price for you, what’s the plan that’s
best suited for you, and go ahead and sign
up right there and then. And that the open enrollment
period will last from October 1st
until the end of March and so there will be
six months for folks to sign up. Normally, this would be
pretty straightforward. A lot of people don’t
have health insurance. A lot of people realize they
should get health insurance. But let’s face it,
it’s been a little political, this whole Obamacare thing. [laughter] And so what you’ve had
is an unprecedented effort that you’ve seen ramp up
over the last month or so in which those
who have opposed the idea of universal health
care in the first place and have fought this
thing tooth and nail through Congress and through
the courts and so forth have been trying to scare
and discourage people from getting a good deal. And some of you may have seen some of the commercials out
there that are a little whacky. And the main message we have — and we’re using social media,
we’re talking to churches, we’re talking to
various civic groups — and what we’re saying
to people is, look, just go to the website yourself. Go to healthcare.gov; take a look at whether
this is a good deal or not and make your own decision about whether this
is good for you. Because what we are confident
about is that when people look and see that they
can get high-quality, affordable health care for less
than their cell phone bill, they’re going to sign up. They are going to sign up. And part of what
I think the resistance that we’ve seen ramp up particularly over
the last couple of months is all about is the opponents
of health care reform know they’re going to sign up. In fact, one
of the major opponents, when asked, well, why is it
that you’d potentially shut down the government at this
point just to block Obamacare, he basically fessed up. He said, well,
once consumers get hooked on having health
insurance and subsidies, then they won’t
want to give it up. [laughter] I mean, that’s —
you can look at the transcript. This is one of the major
opponents of health care reform. It is an odd logic. Essentially
they’re saying people will like this thing too much and then it will be
really hard to roll back. So it is very important
that people just know what’s out there,
what’s available to them, and let people
make up their own minds as to whether
it makes sense or not. Now, one last thing
I want to say, because I do think sometimes — people come up
to me and they say, well, if this is
such a good deal, how come the polls
show that it’s not popular? Well, one of the things
you and I both know is that when you
come to health care, there’s no more personal and
intimate decision for people. I mean, this is something
that people really care about. And frankly,
the devil you know is always better than
the devil you don’t know. And that’s what
“Harry and Louise” was all about back
in the ’90s, right? It was scaring people with
the prospect of change. And so part of our goal here
is just to make sure people have good information. And there has been
billions of dollars spent making people scared
and worried about this stuff. And rather than trying
to disabuse people of every single bit
of misinformation that’s been out there, what we’re saying is
just look for yourself. Take a look at
it and you will discover that this is
a good deal for you.>>President Clinton:
Well, first of all, I completely agree with that. I think we’ve got to just
drive people to the websites. The states that
are participating — the Supreme Court decision
that upheld the health care law said that states didn’t have
to set up these marketplaces if they didn’t want to, but if they didn’t the federal
government would set it up. They also said that states didn’t have to
expand Medicaid coverage to help people whose incomes are up to 138 percent of
the federal poverty level buy health insurance. There are some states,
believe it or not, that want the marketplace
but don’t want the Medicaid. And that’s going to
lead to a cruel result, and there’s nothing
the President can do and it’s not his fault. That’s what the
Supreme Court said. So we can have this bizarre
situation where, let’s say, a business with
60 employees can — or an individual going
into the individual market will get the benefit
of tax credits for everybody with
incomes of 138 percent of the federal poverty
level or above, but they won’t get it for people who are between
100 and 138 percent. So lower-income people who desperately need
the health insurance — we would have the cruelest of
all situations in those states. And there’s nothing the
President can do about it because of the
Supreme Court decision. So we have to persuade
the states to come on. But more and more states
with Republican governors, Republican legislatures
are doing it. Tell them about Arkansas, because we’re doing
well down there. [laughter]>>President Obama:
A little hometown bias,
there’s nothing wrong with that. [laughter] A couple of things
that are happening that I think are
very interesting. First of all, look,
I’m sympathetic to some of these
Republican governors who are under a lot of
pressure because the whole issue of whether you’re
for Obamacare or not has become a litmus test
in the other party. So some of them,
politically it’s been tough; sometimes state legislatures that refuse to allow governors
to go ahead and implement. But as you indicated, what we’ve seen is that
when Republican governors take a look at the deal
they’re getting where, in addition to these exchanges, we’re also providing
a much more significant match, much more federal money
to provide health insurance — from the state’s perspective,
they’re not paying; the federal government
is picking up the tab — and this is helping them
because people are no longer going to the emergency room and
they now have good health care, they’re now getting
preventive care. You’re seeing some Republican
governors step up and saying, I may not like Obamacare, but I’m going to go ahead
and make sure that my people are benefiting from this plan. So that’s one good
thing that’s happening. The second thing
that’s happening is there are
a couple of states — Arkansas is a good example; Kentucky is another
good example; Idaho, interesting example — these are states
where I just got beat. I mean, I do not have a big
constituency in these states. [laughter] Well, I take that back. You know what, 40 percent
is still a lot of people — but I’m losing by 20 percent
in these states. But the governors
were still able to say we’re going to set up
our own state exchanges, their own marketplaces. And each state is just
using their own name for it. So I had a meet —
I had a conference, a video conference with
all the state directors of all the marketplaces, and I’m talking to the
director in Kentucky and Idaho. And in Kentucky, it’s called
like, Kentucky Connect. And in Idaho, it’s called the
Idaho Health Care Exchange. And there’s a story that came
out of Kentucky where some folks were signing people up
at a county fair somewhere. Some guy goes up and he
starts looking at the rates and decides he’s
going to sign up. And he turns to his friend and
said, this is a great deal. This is a lot better
than Obamacare. [laughter] Right? Which is fine. [laughter] Because we — I don’t have pride
of authorship on this thing. I just want the thing to work. And Arkansas just
came out with its rates, and as has been true in
virtually every single state, not only are premiums
lower than they were, they’re a lot lower than even the most
optimistic predictions were about how low they would be. And once these marketplaces
are up and running, it turns out that
what has traditionally been a pretty
conservative principle, which is competition
and choice work, well, in the insurance market,
competition and choice work. And what we’re seeing is that
people are going to be able to get the kind of health care that they have never
been able to get before. States are going
to benefit from it because they’re
going to save money. And one thing
that all of you — there are probably
very few people in this room who don’t have health insurance, although if you don’t, you should sign up
starting on October 1st. [laughter] One of the things that
many people don’t realize is that the subsidy that all
of you provide for the uninsured is about $1,000 per family. You pay $1,000 — everybody here
who has got health insurance pays about $1,000 more
for your families’ insurance than you otherwise would have,
because hospitals are mandated, they are required to provide
service to anybody who shows up. And so what happens is
when you’ve got 15 percent of the population
without health insurance, they end up showing up at
the emergency room typically at a point when
they’re much sicker than if they had been
getting regular checkups and preventive care. So you pay for the most
expensive care there is, because hospitals have got
to recoup that money somewhere. And the way they do it
is to charge higher prices. And people who have health
insurance end up picking it up. So part of what will
help reduce the increase in health care costs
is making sure that that hidden subsidy
no longer exists.>>President Clinton:
Let’s talk a little
bit about business, because we’re out of time, but I think it’s
really important. As you pointed out, most people who have
insurance work for a living, or somebody in
their family does, and they get their insurance
through their workplace. The law says that all
employers have to participate if they have
50 employees or more. Many employers with
fewer than 50 employees already voluntarily provide
some health insurance. Both the companies with
50 or more and the companies with fewer than 50
are somewhat concerned. And the employees that
have to be insured are those who work
30 hours a week or more. So there were many
people who speculated that when this
law came into place that it would add to the cost and there would be
a lot more part-time workers instead of full-time workers. I’ll save the President the time
in the interview on this — so far, that’s not true. The overwhelming number of
people who have been hired coming out of this
recession have been — they have been hired
at lower wages, but they have been
full-time employees. There has not been
an increase in the percentage of our employment
in part-time work. There has been an increase in
relatively lower-wage new jobs. But that means they need
health insurance even more. So explain very briefly to
them how this is going to work, how private employers are helped
to buy their insurance and the requirements.>>President Obama:
Well, first of all,
if you’re a large employer or an employer with
more than 50 employees, you’re already providing
health insurance, you don’t have to do anything
other than just make sure that you can show that you’re
providing health insurance. And there was a lot of news
recently about how we delayed the so-called employer
mandate for a year — because under the law, what it says is if you
have more than 50 employees, you’re not providing health
insurance to your employees, then you’re going to
pay a penalty to help pay for the fact that we,
the taxpayers, are going to have to
provide your employees with health insurance —
which, by the way, is only fair. A lot of the controversy
around the Affordable Care Act had to do with these
so-called mandates, both an employer mandate
and an individual mandate. And the employer
mandate says, if you don’t meet
your responsibilities by your employees, and they end up getting Medicaid or they’re ending up
in the emergency room, you’re basically dumping
those costs onto society. That’s not fair. So we’re going to charge you
a couple thousand dollars to help pay for health care
for those employees. To the individuals,
what we said was we’re going to make
health insurance so affordable, so cheap for you, so heavily subsidized if you’re
not making a lot of money, that if you’re not
getting health insurance then it’s because you just
decided you don’t want to, you don’t need to. And in that circumstance, what happens when you get hit
by a bus, heaven forbid, or somebody in your
family gets sick, and you hadn’t had them covered? Well, we’re going to end up
having to pay for you anyway because we’re not going to
just let somebody bleed in front of the emergency room. So what we’ve said is you’ve
got to take responsibility, and so there’s a small penalty if you don’t get
health insurance. This is where a lot
of the controversy and unpopularity came in, because people generally
don’t like to be told, “you’ve got to get
health insurance,” and employers
don’t like be told, “you’ve got to give your
employees health insurance.” But, as a society,
what we cannot do is to say, you have no
responsibilities whatsoever, but you’ve got
guaranteed coverage. And this raises the whole issue
of preexisting conditions, which we haven’t talked a lot
about but is really important. One of the central
components of this law, one of the main perversities
of the health care system before this law passed was
there were millions of people around the country who,
if you had gotten sick before, if you had had a heart
attack, if you had had cancer, if you had diabetes; let’s say, when it first
happened you had a job, you got cured;
then you lose your job or you’re trying to
change jobs or you’re trying to start a business, you try to go out
and get health insurance, the health insurance company
not only could deny you but had every
incentive to deny you. Because, basically, they’d
rather have healthy people who are paying premiums and
never asking for a payout. They don’t want
somebody who actuarially they can anticipate
might get sick. And so, keep in mind that a huge
percentage of our society has some sort of
preexisting condition, and they can be locked out. You can do everything
right, work hard, build a strong
middle-class life, but if you’ve been sick
and then you lose your job or something happens, you may suddenly be locked
out of the insurance market, or the premiums may be
so high that only somebody fabulously rich could afford it. So what we said is,
all right, you know what, insurance companies,
you can no longer bar somebody from getting health insurance just because they’ve got
a preexisting condition. But the only way that works is
if everybody had a requirement to get health insurance. Because think about what happens
if you don’t have that rule. Well, all of us —
not all of us, but a lot of us who were trying to figure
out how to save some money would say, well, I’m not
going to worry about it until I get sick, and then right
when I’m diagnosed with something that’s
going to be expensive I’ll go to the insurance
company and say, you can’t prevent me from
getting health insurance just because I’ve got
a preexisting condition. So they could potentially game
the system and it wouldn’t work. So now what we’ve done is said you’ve got to provide
health insurance to anybody, all comers — that’s the deal. The flipside of it is everybody
has got some responsibility and we’ll help you pay for it
to get health insurance. And that’s where a lot
of the misunderstandings, the frustrations about
health care reform came in. I should add, by the way, that
this was the same proposition that was set up in Massachusetts under a governor
named Mitt Romney that’s working really well. Ninety-nine percent of
the people in Massachusetts have coverage. And that same principle
was, ironically, considered a very smart Republican
conservative principle. But it was the right one. The economics of it are true. So, just to finish
up the question, when it comes to businesses, if you’re already
providing health insurance for your employees,
that’s great. You don’t have do much
other than just make sure that you show us that
you’ve got health insurance for your employees. If you have more
than 50 employees, and you’re not providing
health insurance for them, you now have the
opportunity to join a pool of small businesses
to get a better price and a better deal
on health insurance. You’re eligible for tax credits in providing health
insurance to your employees. Up to 35 percent of
the premiums for each employee will be a tax benefit — a tax credit from
the federal government. But if you still aren’t
providing health insurance for your employees after that, then we’re going to go ahead
and penalize you for it. And I can understand
why some businesses wouldn’t want to pay for it. If they’re not currently
providing health insurance for their employees,
what that means is that they’d rather
have those additional profits than make sure
that their employees are getting a fair deal. In some cases,
they may be operating under some very small margins. But keep in mind,
since people are — companies are exempted, the average small business
with five employees, mom-and-pop shop, 10 employees, they’re not under
that requirement. So I’m not that
sympathetic to a company, typically, if it’s got
more than 50 employees and generating some
significant revenue, we’re making it affordable for
them to provide health insurance for their employees. They should do the right thing. [applause]>>President Clinton:
I agree with that. We have to close, but I think
there’s one last issue we ought to deal with. The most important
thing obviously is just to get people
enrolled in this. We’ll work through
it as we go along. But you just heard
the President say that so far in virtually
every state, the actual prices of
the insurance are coming in quite a bit lower than they
were originally estimated to. With the original
price estimates and with the
government obligated to provide subsidies — which costs money on
the budget, right? — it was, nonetheless, estimated
that in the first 10 years, this would keep the national
debt $110 billion lower than it otherwise
would have been, which means if
we come in at even less, we can bring the debt down more, or we can subsidize
more small businesses and get more small
businesses into this loop. A lot of people come
up to me and say, now, you sound like the people
you used to criticize who say we could
cut taxes all day long, increase spending
and balance the budget. Don’t give me that; this sounds too good to be true. So I think before you leave, you should tell people
how we can spend more — not so much
in direct spending, but in tax credits — and still wind up reducing
overall federal spending by $110 billion
during this decade.>>President Obama:
Well, a couple of things just in terms of how
this whole thing got paid for. First of all, I think it’s
really important to point out here that the total cost of the
Affordable Care Act to provide health insurance for every
American out there at an affordable rate
is costing about the same amount over the course of 10 years as the cost of the
prescription drug bill that President Bush passed —
except that wasn’t paid for. We felt obliged
to actually pay for it and not just add to the deficit. [applause] So what we did — it’s paid
for by a combination of things. We did raise taxes
on some things. We, for example, said that for
high-end income individuals, you can pay a slightly
higher Medicare rate — Medicare tax. So we bumped that
up a little bit. We said that for employers
who are currently providing a so-called Cadillac
health care plan, where there are so many
bells and whistles, there’s no incentive
to actually spend wisely when it comes to health care — we’re actually going
to penalize you for that — not only to raise
a little bit of money, but also to say you’re
encouraging the worst aspects of a health care system
where you spend a lot of money, you don’t get better outcomes. I mentioned to you Medicare. We basically said — there’s
a program in Medicare called Medicare Advantage that provides
some additional options for Medicare recipients above
and beyond standard Medicare. And it’s very popular
with a lot of seniors. You get eyeglasses
and other benefits. But it turned out
that it was so uncompetitive that we were providing
tens of billions of dollars of subsidies to
the insurance companies under this
Medicare Advantage Plan without getting better outcomes,
health outcomes for seniors. So what we said was
we’ll keep Medicare Advantage and we’ll give
them a small premium if they’re providing
better services for seniors, but we’re going to make
you compete for it a little bit. And we’re going to save
tens of billions of dollars in the process, and that will go into paying
for the Affordable Care Act. So the bottom line is, through
these various mechanisms we raised enough money to pay
for providing health insurance for those who don’t have it, to provide these
tax credits in the marketplace, and at the same time, because we’re
driving down costs, we actually end up
saving a little money. It is a net reduction
of our deficit. The irony
of those who are talking about repealing Obamacare
because it’s so wildly expensive is if they actually
repealed the law, it would add to the deficit. It would add
to the deficit. Now, there have been a couple
of Republicans in the House who have been smart
enough to say, we’re going to repeal
all the benefits so that 25, 30 million people
don’t get health insurance, but we’re going to keep
the taxes that Obama raised, we just won’t talk about that. And then, that way we can
say we reduced the deficit. But obviously, you’re doing
some funny business there with the budget. But, look, nothing is free. The bottom line, though,
is do we want to continue to live in a society
where we’ve got the most inefficient
health care system on Earth, leaving millions of people
exposed to the possibilities that they could lose everything
because they get sick? Or we’ve got little
children and families going to the emergency
room once a week because they’ve got asthma
and other preventable diseases, because their families
aren’t linked up with a primary care physician who is providing
them regular care? Where the costs to society
for reduced productivity, illnesses, et cetera,
all burden our businesses? Is that the kind of
society we aspire to? And I think the answer is no. And the notion
that we would resist, or at least some would resist
as fiercely as they have, make this their
number-one agenda, perpetuating a system
in which millions of people across the country, hardworking Americans
don’t have access to health care I think is wrong. [applause]>>President Clinton:
We have to close. But I will close with a story. I told you all this
morning that the employee that our health access program
lost in the Kenya mall shooting was a Dutch nurse. And we spend a lot of
time in the Netherlands; we get a lot of support there. Oxi is one of the biggest
insurance companies in Europe. They’re one of
our partners here. I went to celebrate their
200th anniversary with them. They started as a fire insurance
company with 39 farmers, 200 years ago. And we were out there in this
big farm field in a tent in the shadow of a 13th century
church and a big Dutch windmill. And I asked the chairman
of the company, I said, do you write health insurance? Because in the Netherlands there’s no Medicare
and no Medicaid, everybody is on
an individual mandate and you just subsidize
people based on their incomes. He said, yes,
I write it; we all do. And he looked at me and he said, but we don’t make
any money on it. And he said, we shouldn’t. This guy is running a huge — can you imagine somebody
saying that in America? [laughter] He said, we shouldn’t. If I can’t make money
on this business doing traditional insurance business, I’ve got no business
in the work. He said, look,
health care is a public good and you’ve got to find a way
to finance it for everybody. [applause] And he said, it’s just
an intermediary function that somebody has to handle. But in the end, it’s how it’s
delivered, how it’s priced, and how healthy you
can keep your people. So the First Lady is trying
to keep us all healthier, and you’re trying to change
the delivery and the pricing. And you have to cover
everybody to do it. I think this is a big
step forward for America. This will, over the next decade,
not only make us healthier, but it will free up in the
private sector largely funds that can then be reinvested in
other areas of economic growth, and give us a much more
well-balanced economy. But, first, we’ve got to
get everybody to sign up.>>President Obama:
Everybody, sign up. Go to healthcare.gov. Thank you very much. [applause]

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