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tv   Meet the Press  MSNBC  November 16, 2014 11:00pm-12:01am PST

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this sunday, what appears to be another beheading of an the victim is apparently peter kasich, a former aid worker. the gloves are off, again. >> what i'm not going to is wait. >> a president no longer constrained by another election. on the other side, triumphant republicans. at stake, two huge issues, immigration and healthcare. >> we're going to fight the president tooth and nail. president obama prepares to bypass congress. >> it's overdue. >> how will republicans respond? also, will republicans
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follow through on their goal to dismantle the affordable care act? where you stand on the issue -- >> it's more taxes. >> may depend on where you sit. >> the people that want to repeal, you go without insurance and tell me how you feel. following the republican midterm wave. can democrats reassemble their winning coalition in 2016 without president obama on the ballot? i'm chuck todd. joining me with, chris matthews, helene cooper, carlene and sylvia burwell are here. welcome to sunday. it's "meet the press." good morning. we begin with grim news from syria. intelligence officials are
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investigating a video that was posted online purportedly by isis that claims to show that captured u.s. aid worker peter cassick has been killed. he was 26 was working as a humanitarian aid worker in syria when he was captured in october of 2013. he was born peter cassick but changed his name after converting to islam while in captivity. the national security council has released a statement. i'm joined by richard engel in i'm joined by richard engel in istanbul where he has been based to cover this war. richard, it seems as if the government is assuming this video is authentic. what do you know?
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>> well, i've seen the video. unfortunately, it does appear to be authentic. we see the same now familiar militant dressed in all black with a distinctive london accent saying that peter kassig has been killed. you don't see the beheading. you see the militant and then what looks to be peter's head at his feet. it was a long video. it shows the beheading of other hostages, a group that are allegedly syrian soldiers. if, in fact, it's confirmed that kassig was murdered, he would be the fifth western hostage killed by isis. the reason they said they killed him is because he was a former soldier who served in iraq before he changed his life and went to syria to help provide some humanitarian and medical relief to syrian victims of war. >> speaking of iraq, again martin dempsey, the chairman of the joint chiefs, he made a surprise visit to iraq yesterday. i think he is still there. he is supposed to get a look at the iraqi military.
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we have advisors on the ground. there's talk ta maybe more have to go. what is the state of the iraqi military, and how are they doing in the fight against isis? >> i think it's very mixed, frankly. there are some units of the iraqi military that are making progress. they made advanced north of baghdad in the last several days. but the military is infiltrated. just a few weeks ago, in fact, a unit from the iraqi military backed up by militias and killed some isis but then they went back and butchered sunni civilians in the town. this was an act, according to officials i have spoken to, directly carried out by an iranian-backed group within the iraqi security services. so i think it's a very mixed record of success so far. the kurds are making advances. some units of the iraqi army are making advances. others are running back death squads. this is the iraqi army that we
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are supposed to be guiding, advising and leading in a fight against isis. >> looks like it's a longer slog than anybody wants to deal with. richard engel this morning, thanks very much. now i want to switch gears, get to domestic politics. immigration reform. democrats now want it. republicans, not for what the president wants. then president obama says he is going to go ahead with or without the gop. the other is healthcare reform. it's president obama's signature achievement, his place in history. here come the republicans. they want to take it apart. there are two issues so important to each side that neither is willing to give any. defy the side and you are declaring political war. that's what's happening. fasten your seat belts, it's going to be a bumpy night. if republicans thought a wave election would humble the president, he didn't show it. promising executive action that would stop deportations for millions of undocumented
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immigrants, a lightning rod for the gop, the president doubled down. >> that's going to happen. that's going to happen before the end of the year. >> we're going to fight the president tooth and nail if he continues down this path. >> so much for the happy lunch at the white house last month. there's healthcare. yesterday marked the premiere of season to of obamacare. the president now playing sales man and chief. >> you can go online or call 1-800-318-2596 and get covered for 2015. >> new website, new cast and this time administration officials hope a new story line. after a disastrous debut last year. >> nobody is madder than me about the fact that the website isn't working as well as it should. >> 7.1 million americans signed up and paid by the end of the first enrollment period hitting projections. this time around, the government expects a total of between 9 million and 10 million for 2015. that's over 3 million less than the government's original projection of 13 million
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signups. yes, the future of the law remains somewhat cloudy. 13 states plus d.c. run their own health insurance exchanges. 38 states, mostly with republican governors, haven't set up their own exchange and rely on the federal government. but what the affordable care act is doing for the cost of healthcare, this map shows the change in premiums from the last largest cities. it's up in some and done in others. in january, the new republican majority takes off promising to dismember the law. >> i want to pull this law out root and branch. >> the supreme court will hear another case this term about those exchanges which could cripple the law. i'm joined now sylvia matthews burwell. welcome to "meet the press." i want to start with -- we heard the president earlier this morning or yesterday or
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tomorrow, however you want to talk about australian time. 23,000 new applications. do you have any up to date numbers? it seems as if new applications went well. people trying to get to old accounts struggled. >> yes, i do. yesterday, we had 100,000 folks submit their new applications. and there were over 500,000 people who logged in effectively yesterday as well. so i think the vast majority of people coming to the site were able to get on and do what they were intending to do. >> do you have an issue with people getting on to their old accounts? is that an issue that you have identified, or is this just user error? >> with regard to that, we think the vast majority were able to. that's what we see in the 500,000. in some of those, we're tracking them down. that's part of what i said we're going do and what we want to do. some people people forget user names. some people are renewing their passwords. our customer service folks are
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ready and able to help people. there were over 100,000 calls yesterday. >> all right. let me ask if you guys have things -- the uninsured rate has dropped, the average premium has gone down for 2015, medicare sol solvency has increased. the public's opinion hasn't changed. still more people think it's a bad idea than a good idea. why is that? >> i think -- >> why hasn't success translated? >> one of the things is we need to translate the success. when you ask the american people about those things individually, or when you ask the american people about the importance of no longer being held off healthcare because of pre-existing conditions or the fact that their children up to the age 26 can be on their plans, that's 3 million. when you ask them about the substance of the issue, the american people respond positively. that's what i think we need to do more about. i think what we need to do is make sure we're communicating clearly and we talk about what is the substance instead of
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something that's one word descriptions. actually, what this is, this is about three things. affordability, quality and access. and when you talk about as you just did the measures against those things, that's what we need to do more of. >> why did you need to downgrade expectations of how many people would sign up? you are looking at less than 10 million. the original projection was 13 million. >> the 13 million was the original scoring. it is done to determine -- >> they were accurate about year one. >> with regard to that, what we have done is when i got to hhs, i asked the team to look at the up ins and let's figure out what we think the target should be. it has two pieces to it. reenrollment and new enrollees. with regard to the reenrollment, what we did was went out to the marketplace, what is the general re-enrollment of this type of thing? they created a range 70% to 90%. many of the people were in the 80% to 85%. we chose 83%. then what we did was build the
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number that way. in setting our target what we did was take the information from last year, including the fact that when cbo did its estimates and others did estimates, they thought more people would switch from employer-based care than did. >> you think that's one of the reasons, that employers haven't dropped people? this is the first year the employer mandate, do you expect to see employers drop people now? >> with regard to the number, we think it's a number of elements. as we made the number that we chose, that 9.1, we said there would be 28% growth. we believe in the second year of a new marketplace, 28% growth is strong and healthy. >> i got to ask you about the comments from jonathan hooper. he is an opponent of the affordable care, have been pointing to the comments all week long. he's an mit professor. he's an adviser to the healthcare law and people that wrote it when the administration was working on it. i understand you didn't work with him very closely. i do want to have you take a listen and get you to respond. this is how he explained taxing
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high-end cadillac health insurance plans and doing a little oakie doek. >> we tax the insurance companies. they tax us. it's a very clever exploitation of the lack of economic understanding. lack of transparency is a huge political advantage. basically, that was really critical to getting the thing to pass. what does this do? this bill takes what i call the spaghetti approach. which is takes a bunch of ideas that might work and throws them against the wall and we see what will stick. >> he is playing into every fear that many had about this bill, it's not transparent, that there are things in it that people don't know. this can't help a credibility gap. >> i have to start with how
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fundamentally i disagree with his comments about the bill and about the american people. since i've been at the department, one of the things i focused on is transparency, making sure all our numbers come out whether good or bad. the law is based on the issues of transparency and belief in the american people and choices in the marketplace. this past week, since we have had window shopping on, over a million people have come to the site and done window shopping. they are comparing based on premiums. they are comparing based on deductibles. when you give the american people to choices, they will do that. from the issue of the consumer to the fact that we have put out information so that people can see what providers are receiving from pharmaceuticals. >> he said spaghetti at the wall. he said that with -- it was the week the healthcare law passed. is that what this bill is, to see what works and what doesn't? >> this law is a piece of legislation that's about three
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things. and these are things that have bipartisan agreement. affordability, access and quality. that's what the american people want. and there's bipartisan agreement. the bill has different pieces. you touched on many of them -- people know about them, whether closing the medicare doughnut hole. there are 8 million american seniors that benefitted from that $11 billion. there are so many parts of this law that target those three things. >> is he welcomed back as a consultant? >> certainly right now in terms of the work that we're doing at hhs, we're doing our work and focusing on what we are doing and our modelling. >> he's not welcome back? >> with regard to mr. gruber and his comments, i think i've been clear. that's something we disagree with. >> thanks for coming on "meet the press." >> thank you. now joining me since the affordable care act was implemented, 23 states have not expanded medicaid. what does it matter?
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let me show you an example. arkansas saw their uninsured rate decrease. in louisiana, the rate was reduced by less. let's go to the number. look at arkansas your neighbor to the north. i i know you don't want to talk about arkansas considered what happened last night with lsu. expanding medicaid, would you have more people off the uninsured rolls. >> democrats and republicans both want to represent the vulnerable, want to help people get healthcare. medicaid is not the right way. the problem with expanding medicaid and obamacare is that it chooses a top down closed approach where the government is running your healthcare. medicaid is a program with bad healthcare programs.
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they showed there was no improve with physical outcomes. it was designed to take care of the disabled, vulnerable children. it was never designed to be there for able bodied adults. the affordable care act, the president is doubling down on a failed approach to providing healthcare. >> why aren't you -- here is the thing. it would cost your state nothing. you may -- you have your own fiscal problems with the deficit issue. would you have more money from the federal government. they are paying for it. it's not going to cost state money. why not do it until the -- while the law is active in. >> that's a great -- i'm glad you asked that. one of the things i love is when democrats say this is free money. this is not free money. every dollar we don't spend on medicaid is another dollar we don't have to borrow from china. this is the reason we have nearly $18 trillion in debt.
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louisiana taxpayers are federal taxpayers. we have to stop acting like all of of this money is free money. secondly, when you look at the best way to help folks, it's to decrease the cost of healthcare. i propose a plan to replace obamacare. if the president were serious, why not give states more flexibility? >> but he has. look at indiana -- why is john kasich wrong? they did get the federal government to approve a different plan. why not negotiate with the government and do something that you want to do? >> if we were to expand medicaid it would cost my taxpayers $1.8 billion over ten years. we would have to get more than one person out of private insurance. i know this president likes to define success as more people depending on government. would have to take over 200,000 people out of private insurance and put them into medicaid. >> 200,000 people not insured at all. >> i'm saying for every uninsured, you take more than another person out of private
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insurance. in louisiana in particular, we inherited a public hospital system. we had ten state operated hospitals through the private sector. we have improved healthcare access and outcomes for one example. it used to take ten days to get a prescription filled. now you can get it done in ten minutes. we reformed our program. over 80% of our -- my point is, there are better ways to provide healthcare to the vulnerable. it's not for the government to run healthcare. the answer is not to expand a failed program, a one size fits all like medicaid. >> you think it's a total failure? >> i think when it was targeted for the disabled, for children, in louisiana we cover over 95% of our children have coverage. i think it could be improved with more flexibility. this wasn't a conservative study. the harvard study showed when you expanded medicaid, there was
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no improvement in physical healthcare. giving them a doctor without giving them access to doctors, hospitals, doesn't improve anything. >> on immigration, if the president goes through with the executive action, do you think republicans should use the power of shutting down the government to stop him from doing it? >> i don't think the president should shut down the government to try to break the constitution. the reality is -- >> you think the president would shut down the government? you do want republicans to fight him on this? >> i don't think the president should shut down the government. >> you are twisting my question. >> let's step back -- >> you want that show down? >> the president said i want to break the law. he said i'm going to wait until after the election. i know it's not going to be popular. we had an election. he said his policies were on the
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ballot. he lost in red states, purple states, blue states. the people rejected his policies. now he is saying, i'm going to break the law. talk about arrogance. where was this president said elections have consequences, we are talking about how can the congress force the president to follow the law? i would expect democrats who may agree with him on substance to say the right way to do this is to follow the constitution, follow the law. we shouldn't shut down the government. but republicans should do everything they can to force the president to follow the law. let's secure the border. the president shouldn't shut down the government. >> i want to ask you about presidential ambitions. majority in louisiana disapprove of your job. why is that a launching pad? >> i don't care about poll numbers. i never have. i was elected in louisiana to make generational changes. look at what we have done in louisiana. now we have cut our state budget 26%, cut the number of state employees 34%. we have the best private sector economy in a generation. our economy has grown twice as fast as the national economy. more people working than ever before at a higher income than ever before. we transformed the charity house. that's the third wheel in louisiana politics. state wide school choice. if i were to run -- i haven't
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made that decision. if i were to run for president, it's because i believe in our country the american dream is at jeopardy. this president has defined the american dream as more dependence on the government. we need to restore the american dream. it's more about opportunity and growth and not redistribution. >> one part of your record -- you have nearly a $1 billion hole in your budget. your deficit has grown. you did a big tax cut at the beginning of your term as governor. revenues haven't followed. >> that's not true, chuck. the billion dollars is the assume we grow. our budget has balanced every year. i have had eight credit upgrades in the ratings. we have balanced our budget every year without running deficits, without raising taxes. >> you have to. >> we need to do that in d.c. as well. we have made tough choices, unlike d.c. we cut spending $9 billion. i'm not talking about cutting growth. we cut our budget by $9 billion.
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we have balanced our budget. we have done it by growing the private sector. we have more than 80,000 jobs, more than $50 billion in private investment coming into our state. we are -- our economy is doing so well, when i was elected, our wore are i was we were losing our sons and daughters. today our biggest challenge is filling all these great jobs. >> governor bobby jindal, you will decide by the new year. president obama said election -- what election? the midterm losses haven't stopped him, they seemed to have energized him. how will republicans respond? hee what i'm wearing, i tell them aveeno®. because beautiful skin goes with everything. [ female announcer ] aveeno® daily moisturizing lotion has active naturals® oat with five vital nutrients naturally found in healthy skin.
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welcome back. this month's midterm results were miserable to the democrats party. they lost the senate and seats in the house. with two years of his tenure left, the president has two things to do. he can be bold or compromise. this week it became clear the president has opted to favor the latter approach. he may believe the best form of a defense is a good offense. >> without any republican
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support on anything, then it's going to be hard to get things done. >> that was four years ago. this is now. >> there will be actions i take they don't like. >> in 2010, president obama realizing he would be facing voters in two years walked away with a pledge to build consensus. the effort failed. a grand bargain on taxes broke down. clashes paved the way for a government shutdown. this time around, the president is learning a different lesson from defeat. with time running out to secure a legacy, this week the president put his fists up, telling supporters, let's go. >> i'm laying out a plan to keep the internet free and open. >> the president pushed the fcc to issue the strongest possible rules for internet service providers, saying the internet should be regulated like a public utility so broadband companies can't charge for better access. republican senator ted cruz
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called it obamacare for the internet. on tuesday, mr. obama announced a climate deal with china designed to cut carbon emissions from both countries. >> for first time, we got china to make a commitment to constrain its green house gases. why would anybody be against that? >> republicans were. >> i had naively hoped the president would look at the results of the election and decide to come to this political center. but the early signs are not good. >> as early as next week, the president will give republicans another target when he acts alone to extend protections to as much as 5 million undocumented immigrants. >> we're going to fight the president tooth and nail. >> it's like waving a red flag in front of bull. >> the president may have said i hear you, but it's just the opposite. >> republican leaders hoping to prevent a government shutdown and avoid upsetting conservatives are considering the courts. >> i would advise rather than
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devote time trying to constrain my lawful actions as the chief executive of the u.s. government in charge of enforcing our immigration laws that they spend some time passing a bill. >> now instead of worrying about shoring up red state incumbents, he is working on firing up base democrats who stayed home on election day. contributing to the lowest overall midterm turnout in more than seven decades. that may mean picking a fight with members of his own party. democrat soul searching revives a rift between moderates and progressives. the first skirmish, a senate vote next week on the keystone pipeline. >> i would like to vote on keystone now. >> understand what this project is. it's providing the ability of canada to pump their oil, send it through our land down to the gulf where it will be sold everywhere else. it doesn't have an impact on
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u.s. gas prices. >> well, the panel is here. i want to start with keystone. chris, the president, is he going to veto it? is that a death knell? >> this time around, it's veto. but it's going to come back again and again. it will be negotiated. >> is it a mistake to veto it? >> he may feel he has to do it for his environmental supporters. it's not going to stop it. it's going to happen. it will happen. it will happen now or next year or the year after. the country wants jobs. energy is a primary concern of the american people. look where the election -- working class white, hillary clinton will want, they will be for jobs. he said there's nothing in it for us. there are jobs in it. that's the way the american people look at it. not energy, jobs. >> are you surprised at this more energized president obama? >> i'm not. i think it's interesting though, because somebody clearly didn't tell him that his party got whipped. >> it wasn't close. >> so it's really interesting seeing how he has come out. he is clearly shooting for the
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fences. he is thinking about his legacy. he wants to get things done. i think that's why you are going to see him doing much more things on the international stage where he has more ability. i think he's -- for all of the nice talk that you heard the day after election about trying to get along, that's not going to happen. i think we're in for two years of complete gridlock. >> what should republicans do if the president wants to basically still enact his agenda and not let the midterms interrupt that? >> just on keystone pipeline, perhaps the president will veto this. on what basis would he do so? the american people support it by wide majorities. what we are doing today is actually worse for global greenhouse gas emissions than the keystone pipeline would be. it would create jobs despite his bizarre statement that it wouldn't. finally -- >> there are mixed studies on this. >> 2 1/2 years of a process,
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that's purposeful foot dragging or incompetence. the american people know that. i think what the republicans should do is soberly and systematically pass bills that make sense, that have bipartisan support. keystone pipeline is one of them. they should pass it. if he jumps in and does the executive action on immigration, i think republicans should not be goaded in -- >> showdown? >> showdown, because it only helps obama and hurts the american people. what they should do is systematically and soberly pass bills to solve a problem and they should point out to hispanics all over this nation that this president has taken
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advantage of them. he sunk comprehensive immigration reform in 2007. he did nothing to push forward >> it does appear as if the president is looking at different democratic groups and going to the base. >> your point that this is the beginning of a feud between the two factions -- >> you think there is? >> i think it's correct. it's more valuable for mary landrieu to be against him and have him veto the pipeline for her to actually be able to deliver it. here where he -- >> you think it's better politics for her? >> it certainly is. in a state where her -- >> if she can't get something she wants to get done, that's good for her? >> she's not going to be able to convince voters she's not another vote for the president. this is the constant problem that democrats across the country had. they were too closely tied to him. why not do everything possible to distance yourself from the white house? >> a veto might help her? >> she doesn't have great chances either way. >> before december 12th, too. ten days, they have to veto one way or other. it's going to happen. >> all right. you are coming back. we will talk more about this coming up. democrats stayed home on election day. can they reassemble the
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coalition if he's not on the ballot. my "meet the press" nerd screen segment is next. od job. i like it when my toothpaste lets me know too. that's why i went pro. go pro with crest pro-health. for an intensive clean. i can really feel it deep cleaning my mouth. for a 4x better clean try these products together. that was a great check up.
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doesn't build up for a flawless nude look find your trublend at easy breezy beautiful covergirl the democrat the democratic party's prospects for 2016 are all about who shows up to vote. one reason president obama did so well in 2012 was due to minority and youth turnout. in fact, let's look at 2012. 72% of that vote was white. 13% black. 10% hispanic. 19% was between the ages of 18 and 29. now, here is what we know. whites voted for romney by nearly 20 points. if you look at everybody else, blacks, hispanics, asians, the president won that share of the
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vote 80% to 19%. let's look at what happened last tuesday. turnout was low. the percentage of white voters was up. black and hispanic numbers dropped. most significantly, that 18-29 vote, dropped down to 13% of those who voted. guess what that did. it helped produce the gop wave that we saw. here are two states where a turnout that looks like 2012 likely would have changed the outcome of the election. colorado and north carolina. in colorado, cory gardner beat mark udall by 42,000 votes. look at this. between 2012 and 2014, the youth turnout in colorado, mostly democratic voters, dropped from 20% of the electoral to 14%. the youth turnout had held steady, probably would have produced enough votes to put udall over the top. let's look at another example, north carolina.
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thom tillis beat kay hagan. had the african-american turnout by the same as it was in 2012, senator hagan would have won. it would have produced 56,000 more votes. it would have led to a different outcome. many have argued you need someone like obama at the top of the ballot to get the turnout that favors democrats. if that is true, then democrats could have a problem. obama will not be at the top of the ticket. the long-term shift in demographics in the united states probably will help the democratic party in the next presidential election when turnout will be higher. experts expect the white vote to be about 69% and that alone could help almost any democrats no matter who is at the top of the ticket, even if his name or her name is not barak obama. tity pennington.
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'. welcome back. a little earlier i discussed the pollitys of healthcare with secretary burwell and governor > jindal. what difference has the affordable care act made? i asked ann thompson to look at texas and illinois. they took very different approaches to the law. >> everything is bigger in texas, including the opposition to the affordable care act.
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>> it's going to be more taxes on all of texas people. that's a trap. >> 1,000 miles away in the land of lincoln and the current president, it's also called the aca and embraced. >> the aca saved us. >> one year later, two states with different assessments. robert mayfield heads a sizzling business in texas. he employs just under 100 people at above minimum wage. >> we pay $10 an hour to start. we don't do that because we're nice. >> he wants to expand the business started by his father in 1949. going over that 100 employee mark means he would have to offer healthcare to most of his full-time workers or pay penalties under the laws. >> these costs, they don't come out of the air. if we have to pay them, we have to pass them on. >> if 30 hours a week is how the
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law defined a full-time worker, forget expansion. he may have to cut hours or jobs. >> we have people that i care very much about that work for us ten, 12 years. what i do with them? >> texas has the highest percentage of uninsured in the nation, 6 million people. only 733,000 signed up for the aca. >> it was just characterized that this is going to be the panacea to our issues. it's not and never was. >> this man hears complaints who pay for more less coverage. though texas rejected the medicaid expansion, this republican doctor is open to other ways. >> there's a possibility to look at ways of how we provide insurance or some kind of program to the people for which there is not an option for right
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now. >> in washington, the incoming republican majority vows to repeal the law. fighting words in keith moon's house outside chicago. >> the people that want to repeal this, they sit there with insurance. you go without insurance for two years and tell me how you feel. >> his family did, after he and his wife lost their jobs. joyce's pre-existing thyroid condition pushed the price tag for insurance to an unaffordable $1,750 a month. >> as a husband, your wife isn't getting the attention she needs. >> it was terrible. you felt awful about that. >> now with the aca, they pay $300 a month, and joyce gets the care she needs. >> one year later, what's the emotional difference? >> you don't have that overhanging stress and risk of medical bankruptcy. you have that burden lifted from your shoulders. it's just -- i don't know how to put it in words? >> in illinois of the people eligible, more than 700,000 signed up. >> because of the coverage in the affordable care act, a lot of people are more likely to live. families are less likely to go
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bankrupt. >> entering year two, the affordable care act has not healed the divide it created. for "meet the press," ann thompson. for a dive on the policy, i'm joined by dr. toby cosgrove. you worked with the white and in the white house to develop president obama's healthcare law and ovick roy. welcome to all of you. let me start with you, doctor. affordable care act, is it working? >> we have seen several good things happen. it started to decrease costs and the jury is not in on that yet. you have to understand that costs are not just about the individual. they are also about the costs for healthcare across the nation. it has improved -- >> you as the head of cleveland clinic, you would know that? >> we would know. >> are costs coming down? >> we try to make care affordable and greater efficiency and bring up quality.
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we have seen the national quality indicators go up. we certainly have seen access increase across the country. there are -- the main thing that we're seeing is the jury is not in yet on what we are doing as far as costs across the country. >> hospital costs are going up. >> first year, is it not the doom and gloom that was predicted? >> so hospital costs and the underlying cost of insurance for people who buy coverage on their own did go up in year one for obamacare. it's stable this year from the higher levels. a big part of what's happening that people haven't been paying attention to is as more people are on medicaid and medicare, the government insurance plans, hospitals across the country are merging in order to have higher market power to raise prices on people with private insurance. increase premiums for people with private insurance. we see that in northeastern
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ohio. cleveland clinic merged with a hospital system in akron. in general, these mergers have led not so much to increased quality but to higher prices. 44% higher for knee replacement and angioplasty and heart surgery compared to competitive markets in old days. >> premiums -- national premiums are coming down. premiums that people are paying, your out of pocket costs are coming down. we used to have double digit increases. they have come down. it's transforming itself. there's a lot of pressure to bring costs down. there is greater concentration in some areas. sometimes -- most of those cases what we are seeing is that there's better value for the patient. i'm happy to discuss ins and
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outs of particular areas. we have national numbers. medical inflation is down. it's translating into lower premium increases. >> what's the next metric? >> the metrics are going to be around quality, transparency and transparency around cost. we will see those happen over time. that will bring the marketplace to a real marketplace. we need to have people understand and have a part in how much they are paying for their healthcare. and we need to move from sick care to well care. that's going to require that people get involved in their care and understand what they are doing. at the end of the day, you have to understand that the health of the country is only as good as the health of its citizens. we need to work on that hard. >> what would you be advising republicans to do right now? try to dismantle the law? >> make changes to the law based on things -- >> you wouldn't go for the kill on this in. >> the base wants it. they made the promise to the
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voters. republicans in the next two years have to think constructively about how to make the healthcare system better. one of those is to increase access to coverage and care. a big part of that is to make it less expensive. the average day spent in the hospital in the united states costs five types what it does in the typical industrial country. that's way too high. it's not enough to say, okay, we are increasing hospital costs by 2% or 3% next year. we have to bring it down. >> that's one part of the law that didn't -- it focused on insurance coverage. it didn't focus -- it was having a harder time to go after the costs. >> we do have national health expenditures have that have been lowering. i think it's because of aca. >> the economics? >> the economic downturn has had pressure as well. the thing we have to distinguish is that out of pocket costs have been going up for consumers. that's a ten-year trend. employers have been shifting. that's the next area for democrats. i hope republicans -- the next area to concentrate. how much consumers are paying. the law has had a big benefit because premiums coming down. >> we have to understand we're
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going to have a shortage of doctors and nurses. 800,000 nurses a decade and another 130,000 doctor shortage. we have to address that before it gets to be a crisis. >> a little substance with people's sunday morning breakfast. >> i'm all for it. >> thank you all for this. we will be back in 15 seconds with more from the political panel. welcome back. the panel is still here. --i don't know my credit score. that's really important. i mean - i don't know my credit score. don't you want to buy a, ever?
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the panel is still here. i want to pick up on the healthcare conversation. would you be advising full repeal at this point in time? do you think at some point you got to almost stop talking about repeal or no? >> i think that the republican house will pass a bill that repeals it. i think ultimately this bill does -- >> you don't think the senate will? >> i don't think the senate will. let me tell you why i think it needs to be repealed. what happens when you have vast legislative overreach is you don't particularly fix the problem you started out to fix and you create problems for everyone else. that's what we have done. the number of uninsured isn't coming down fast enough. pre-existing conditions, i'm a cancer survivor. of course, that should not be a reason not to get health insurance. but they keep talking about premiums. what they don't talk about is everyone's deductibles have gone up. what they don't talk about is not enough people are getting insured. we have created so many other
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problems. you reference jonathan. this law is longer than a harry potter novel. it happen -- >> wait a minute. >> of course nobody understands it. it has created problems for everyone. >> the healthcare -- you will write a long law. are you not? >> or, you could go to the one force that we know reliably improves quality and lowers costs. it's competition. the health insurance market has never been competitive. between the health insurance companies trying to protect their franchises and big government. >> reed, you helped me on my book. when we went through the healthcare thing, passing the bill became more important than the words in the bill. >> it did. within the white house there was overcorrection the mistakes the clintons had made. they gave a lot of writing authority to capitol hill. that didn't work because of some internal dynamics within the democratic conference up there, especially in the senate. this is a problem for the president from the first day of his administration. it has plagued him.
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it will now continue to do so in the last two years of his term. >> chris, if you are the administration, they still -- they still haven't marketed healthcare well. >> i agree. i want to go to the genesis of the bill. it's the same as immigration. it's the same as immigration. as long as you have an intractable opposition -- i was hoping with he get hatch in on the bill. they were negotiating. they fell off because of fear of the tea party people. same with immigration. please have a meeting between the president and the speaker of the house -- >> they need to meet? >> i like it on television. what is your opposition to the bill? i will give you more enforcement. is it hiring rules? we will enforce them. i promise you we will enforce them. you are against any kind of amnesty for people who have been here 20, 30 years. so what then when the president issues the order, people will understand he tried to negotiate. let me tell you something. we are negotiating with -- why
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don't we have negotiations. >> he brings up a point. i can hear republicans echoing, he will negotiate with iranians but he won't negotiate with us. >> that's not the way i said it. >> i'm telling you that's the way you will requoted. >> they meet at the table and show us what's their opposition to immigration. i'm sorry. >> very quick. >> i think that for the republicans, there's going to be a danger of overreach as well. they right now control the senate. if they are going to shut down the government, what are they going to be for? >> before i let you go, we thought we would end on a happy note. the president is on his way home from the g-20 summit. being australia, the hosts brought out cuddly koalas. look at that. this like him posing with an animal that wasn't faked.
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there's the president, almost getting tickled by a koala. is this a reminder everything goes better with animals? everybody is happier? >> you want a joke? >> before i let you go, are you -- how serious are you about running for president? >> that will be something i considerate the right time. >> you are considering? >> when people ask you over and over again, you have to reflect. i will pause and reflect at the right time. >> you are something -- you are pondering? >> you have to ponder when people ask you. i have been to iowa. >> there's a flight out of d.c. >> that's all for today. we will be back next week because if it's sunday, it's "meet the press."
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