Thursday, February 25, 2010; 4:31 PM
BOEHNER (?): Mr. President? Mr. President? Ms. Blackburn was -- was -- was on the list, I thought, before we left.
OBAMA: OK. Go ahead.
BLACKBURN: Thank you, Mr. President.
And, yes, one of the points that we did want to cover today was the across-state-line purchasing of insurance. You've alluded to that a couple of times and mentioned that you felt like we were close on that issue. I think that there are some very important structural differences in the way we approach this, just as I think that there are very deep philosophical differences in how we approach health care reform.
Now, a lot of the people that I talk to want us to start over in this issue. And they want us to give them the ability to hold insurance companies accountable. One of those ways is through very robust competition.
And when you have a district like mine in Tennessee, where the bulk of our constituents are within 15 miles of the state line, the ability for those individuals who have families and love and work and have employees on the other side of the state line, who shop for major purchases every day, is to allow them to be able to make those purchases.
Also, when you talk about holding insurance companies accountable, if you want to empower patients in front of those insurance companies, take the power away from them, then give them the ability to buy a policy that suits their needs. They are really tired of paying for coverage they don't want.
If you want to prevent premium acceleration, such as the issue in California right now, where the premiums have gone up 39 percent, if you are siding with protecting those insurance companies and not allowing across-state-line competition, then what you're doing is denying Californians the ability to go to Oregon, where they could buy a policy for 25 percent less, or individuals in New Jersey who could go to Pennsylvania and buy a policy and lower their cost 26 percent or go to Wisconsin and buy one and lower their cost 74 percent.
Now, some of the very differences in our bill, we have a way to do this without putting a federal bureaucracy in charge of it. States can already do compacts. But the Senate bill legislation would require state action and then federal approval for those compacts to take place.
There's another important point here: The bill that you all are proposing would not put these in place until 2016. And, quite frankly, I think a lot of the American people agree with us that care delayed and access delayed is care and access denied.
And they would like to see those -- basically what you have, state lines right now basically have stop signs up when it comes to across-state-line access. They would like to see that come down, and like to see those access portals opened up so that they can, first, lower their costs. Secondly, so that they have greater ability to hold insurance companies accountable.
And then, also, state legislators, even some of our governors -- many of the governors favor approaching this model and allowing our constituents a way to access this, get the costs down.
And I will be brief, so that we can move on to other topics. Thank you.
OBAMA: I appreciate that very much, Marsha.
Just to close, because there have been two issues that were raised, one the purchasing insurance across state lines, and the other was the issue of the mandate. And I just want to address those very briefly, and then I'm going to turn it over to Joe.
I support the idea of purchasing insurance across state lines. And you're right that the way we structure it is to have compacts between states so that you start getting a regional market.
But I think there are two things that are important to understand. Number one, with respect to California, for example, the problem as was presented yesterday in California was not that there were a whole bunch of insurance companies from other states who were clamoring in to get into California to sell insurance to those individuals who saw their premiums spike by 39 percent. There weren't.
The problem has to do with the fact, according to them, that people who have lost their jobs now, who are healthy and can't afford the individual market, have basically just decided, "I'm going to go without insurance. I'll see" -- "I've got to take my chances because I just can't afford it."
What that's left is people who because of preexisting conditions, because of special health care needs, because of age, they have to keep their insurance. And so, the pool has become older and sicker.
Now, the way to get at the problem is actually what we've discussed earlier, which is to broaden the pool -- make sure everybody's in the pool. And that's what the exchange is.
I actually think that on the purchasing insurance across state lines, there may be a way of resolving the philosophical difference -- not entirely, but -- but there's a potential way of bridging this gap, and that is to say that once there was a national exchange, with some minimum standards, then potentially you could just have a national marketplace and anybody could be able to sell into the exchange.
This is something that Mike Enzi just mentioned. I actually think that could be workable, once the exchange was stood up. So there may be a way of bridging this difference.
Now, on the mandate, though -- because the mandate issue is connected, and so I'm just going to mention this real quickly, and then I will move on.
When I ran in the Democratic primary, I was opposed to the mandate.
OBAMA: Well -- and I'll -- because my theory was, you know what, people, the reason they don't have health insurance isn't because somebody's not telling them to get it, but because they just can't afford it, and that if we lowered costs enough, then everybody would be able to get it.
So I was dragged, kicking and screaming, to the conclusion that I arrived at which is is that it makes sense for us to have everybody purchase insurance. And I have to say, this is not a Democratic idea. I mean, there are a number of Republicans sitting around this table who have previously supported the idea of an individual mandate -- responsibility.
The reason I came to this conclusion is two-fold. One is cost shifting, which is a fancy term for saying everybody here who has health insurance is one way or another paying for those who don't.
Every time somebody goes into the emergency room -- if Jay's son got hit by a bus and his dad wasn't Jay Rockefeller, and he ends up in the emergency room, we'd give him emergency treatment, and we'd all pick up the tab. And the calculation -- not our calculation, but independent economists -- is each family with health insurance right now is picking up $1,000 to $1,100 worth of costs for people who don't have health insurance.
So when Tom Coburn earlier said, you know, that the kid comes to the emergency room, they're going to get treated. You know, yes, they will get treated. Who's paying for it?
Well, we're paying for it. Every American family who's got health insurance is paying for it. Every employer who is covering their employees is paying for it.
So we're already putting the money in, it's just in a very inefficient way. And so, the notion that somehow, if we don't ask people to carry their responsibilities, that we're saving money, no, we're not saving money; it's just that we don't see it.
OBAMA: It's called uncompensated care, and we all get charged an extra 1,000 bucks.
So that's part of the reason. The second reason has to do with the issue of preexisting conditions and the pool that we've already discussed. But I just wanted to address those two issues.
Marsha, you had one thing...
OBAMA: ... that you wanted to respond to.
BLACKBURN: Yes, Mr. President, I did very quick.
I would just suggest that we're looking at this from -- in your example we're looking at it the wrong way. You're talking about letting companies into California. I'm talking about letting individuals out, empowering individuals.
OBAMA: No, but it's the same -- it's the same idea, Marsha. It doesn't matter whether companies are going in or people going out. I promise you...
BLACKBURN: Free it up.
OBAMA: No, no, no...
BLACKBURN: Free it up.
OBAMA: I promise you that the -- the problem that's going on in California is going on in every state. It's not unique to California. It's not as if there are insurance companies that are giving great deals in Iowa, that gentleman farmer who just talked about. These are some structural problems that exist in every state.
It is -- what is true...
OBAMA: No, I want to say this -- hold on a second, guys -- what is absolutely true is that some states probably have higher mandates than others, and so you can probably attribute a certain amount of the cost in a high -- you know, a state that has more requirements for bare minimum coverage, doesn't allow drive-by deliveries or requires mammograms or what have you -- those things all may add some incremental cost, but the truth of the matter is, is that that's not the reason that you're seeing such problems. In a lot of states, the problem is just you don't have competition at all. We want competition. We just want some minimum standards.