On Tuesday afternoon, Sean Spicer made up a quote from Nancy Pelosi, and nobody complained. In 2010, famously, then-House Speaker Pelosi (D-Calif.) told the National Association of Counties that the Affordable Care Act would become appreciated when it finally became law. “We have to pass the bill so that you can find out what is in it, away from the fog of the controversy,” she said.
Spicer remembered it differently. “Anyone in the country and anyone in the world, could read it,” he said of the GOP's American Health Care Act. “That's a vastly different approach than after it's being done, told, after we pass it you can read it, which is what Speaker Pelosi said.”
Nobody corrected him, but why would they? In the seven years since Pelosi uttered that quote, it has become part of the conservative catechism. Republicans, arguing that the ACA was passed in a hurry — instead of the many, grueling months that reporters remember — slap the Pelosi quote on the table like a royal flush.
Here's the thing — in retrospect, the quote has basically been vindicated. The repeal debate, paradoxically, has pushed the Affordable Care Act to its best poll numbers since before it was passed. Republicans are having an unexpectedly difficult time agreeing on a replacement, in large part because they're trying to salvage parts of the law that voters like.
Pelosi's entire 2010 speech is rarely quoted in full, but the sections right before the killer quote are worth revisiting.
Imagine an economy where people could follow their aspirations, where they could be entrepreneurial, where they could take risks professionally because personally their families' health-care needs are being met. Where they could be self-employed or start a business, not be job-locked in a job because they have health care there, and if they went out on their own it would be unaffordable to them, but especially true, if someone has a child with a preexisting condition. So when we pass our bill, never again will people be denied coverage because they have a preexisting condition.
Little of what Pelosi said ended up as rosy as she predicted, but little was wrong. “Job lock,” the phenomenon of people sticking to jobs they disliked because they couldn't afford health care without it, did indeed decline after the act became law. The rise of the “sharing economy,” which Democrats have found to be problematic for wage growth, was nonetheless enabled by the ACA's creation of health-care exchanges untethered to employment. And the preexisting provisions of the law have proved so popular that Republicans are seeking ways to preserve them.
It will offer paid for investments that will improve health-care services and coverage for millions more Americans. It will make significant investments in innovation, prevention, wellness and offer robust support for public health infrastructure. It will dramatically expand investments into community health centers. That means a dramatic expansion in the number of patients community health centers can see and ultimately healthier communities. Our bill will significantly reduce uncompensated care for hospitals.
All of this was, indeed, part of the bill, paid for by taxes which the Republican repeal effort seeks to eliminate. Community health centers have grown since the ACA's passage, and about 70 percent of their federal grants come from the law's funding streams. Early estimates (from the Urban Institute) of repeal suggest that it would create $1.1 trillion in new costs for uncompensated care.
You’ve heard about the controversies within the bill, the process about the bill, one or the other. But I don’t know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention — it’s about diet, not diabetes.
This also turned out to be true. The ACA made preventive care cheaper or free as part of its employer mandates — this is why plenty of “what if it's repealed” stories focus on the chronic health problems of people who've gotten used to, say, free insulin. It's also why the American Diabetes Association has repeatedly come out swinging against repeal. Every study of the Medicaid expansion has found, unsurprisingly, that people who went from being unable to afford preventive care began getting tested for diabetes and other conditions.
For seven years, the main frustration of Democrats vis-à-vis coverage of the ACA was that the bill's benefits didn't get covered. Stories of people losing their plans because of the new mandates made headlines — low-drama stories about people being able to afford checkups did not.