Thursday, February 25, 2010; 12:52 PM
OBAMA: OK. I'm going to let Rob -- feel free to respond to anything they've indicated, or to any of the other issues that have been discussed.
ANDREWS (?): Thank you, Mr. President.
I want to thank my friend Tom Coburn and John Kline for the spirited conversation which they offered, and try to carry that forward a little bit.
The president asked at the beginning of this what ideas do we share about cutting costs. And Tom, I think you had some very good ones. Fraud -- the president has a proposal that says we should have a database. If you've committed fraud against Medicare once, you can't make a contract again. Wellness -- there's a lot of good ideas in the bills. Junk lawsuits -- I think that there's -- what Secretary Sebelius is doing is very important in curtailing that.
And then the president asked the question about whether we can find agreement on pooling the purchasing power of small businesses and individuals so they can get the same deal that big companies and members of Congress get. And my friend John Kline talked about the association health plan proposal.
Respectfully, John, I think that what you're talking about with association health plans and what we're talking about with exchanges is a semantic difference. It's a matter of pooling the purchasing power of small businesses and individuals to get a better deal. But there is one substantive difference that I want to ask about because we are concerned about it. If we can resolve this, I think we can agree.
Let's take the case of a woman who has a baby by C-section, and she lives in one of the many states that say you can't be kicked out of the hospital after you've had a C-section until your doctor thinks it's time for you and the baby to go home.
Now, under the association health plan proposal, that rule wouldn't apply to that lady and her baby, that there would be no protection of her in that situation. We think, John, that there shouldn't be necessarily, you know, 51 different rules for each state, but there ought to be some minimum federal standards in these exchanges to protect people in cases like that.
So I think the issue is if we could find a way to agree that in a case like this where, you know, a lady has a baby by C-section and has the ability to not have the insurance company get between her and her doctor, so the doctor makes the decision about when they go home, we could figure this out. How do you feel about that?
KLINE (?): Mr. President, if I could -- if I could just respond to that. My friend knows very well that there are large companies today who operate under what I'm proposing for association health plans. They get a waiver. They don't have to comply with the individual mandates of all 50 states, and I don't hear people complaining about the insurance policies that they're getting from their big companies.
ANDREWS (?): We do.
KLINE (?): In fact, many of those now would fall into what we've been calling "Cadillac plans" because they provide very excellent service. So I think that, frankly, is a red herring and I think that we can -- that you're not going to have adequate coverage if you have association health plans working under the same rules as large companies.
ANDREWS (?): But John, would you favor a standard that says they have to do something like that? Or would you just leave it up to the insurance company?
KLINE (?): I would say that we put the association health plans in exactly the same position that large companies today, with exactly the same rules under ERISA.
ANDREWS (?): See, we don't -- I mean, with all respect, we don't agree with that. We don't agree with the idea that the insurance company should get to make that kind of decision about whether the lady goes home Thursday or Sunday.
Now, I don't think that's intrusive, I think that makes common sense. But if we could find a way to bridge that gap, and I think we could, then I think the AHPs that you support aren't all that different than the exchanges that we do, and I would think that would be a common ground.
OBAMA: The -- this has been a useful conversation.
Paul Ryan wants to -- wants to make a comment...
MCCONNELL: Mr. President, can I just interject one quick point here, very quick, just in terms of trying to keep everything fair, which I know you want to do.
To this point, the Republicans have used 24 minutes, the Democrats 52 minutes. Let's try to have as much balance as we can.
(UNKNOWN): I think the Republican leaders are controlling the time for the Republicans, if I'm not mistaken. That right?
OBAMA: I don't think (inaudible) quite right, but I'm just going back and forth here, Mitch.