Speaker Nancy Pelosi On Health, Taxes, Midterms

NPR's Robert Siegel talks to House Speaker Nancy Pelosi about several issues, including health care, taxes and the midterm elections.

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DAVID GREENE, host:

This is ALL THINGS CONSIDERED from NPR News. I'm David Greene.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

And we begin this hour with House Speaker Nancy Pelosi. The California Democrat is touting new health-insurance rules that will take effect this week. They were part of the big health-care bill that's now law. The rule changes come just six weeks ahead of this fall's midterm elections, with the Democrats struggling to convince an increasingly skeptical public that they should be allowed to keep their majorities.

Earlier today, I interviewed Speaker Pelosi at the Capitol.

Madame Speaker, welcome to the program once again.

Representative NANCY PELOSI (Democrat, California; House Speaker): Thank you, Robert.

SIEGEL: One of the biggest achievements of this Congress was the health-care bill, something Democrats had called for, for decades. But in a very tough election season, health care is playing at least as well as a Republican issue - that is, opposition to it - as a Democratic issue. Why is that?

Rep. PELOSI: Well, first of all, let me say that the whole idea of health care - access to health care for all Americans is a Republican idea. President Teddy Roosevelt started this idea over a century ago, and again over the decades, Democratic presidents have tried to advance it. President Obama succeeded. And it is definitely an advantage for us because we have now aligned ourselves with those who passed Social Security, Medicare and now, health care for all Americans as a right, not a privilege.

SIEGEL: But does it frustrate you that people aren't saying all across the country: This is terrific, let's return the Democrats again; they brought us health-care reform?

Rep. PELOSI: Well, let's just say this. Thursday, the - six months after the passage of the bill, certain provisions will go into effect. Your coverage can't be dropped. If you get sick, your child cannot be denied coverage for a pre-existing condition. A child up to 26 can stay on your health-care plan, and your health plan can't get - have a lifetime limit on it. The American people like that.

SIEGEL: These take effect this week.

Rep. PELOSI: They like that. These take effect on Thursday of this week...

SIEGEL: This week.

Rep. PELOSI: ...as well as some other things, but just to name a few that are very popular with the public. So some aspects of the bill are popular with the public. The Republicans - always the handmaidens of the special interests - have long beat the drum about what this bill is not about, and we have not made up that part of the debate.

SIEGEL: But some...

Rep. PELOSI: But we are proud of it, and our members gain strength from their support of it, and we think it will be a very positive factor in the elections.

SIEGEL: But some health-insurance companies look at these very changes and say these are going to mean more payouts over the years from us, greater risks; therefore, now begin higher premiums, sometimes as much as 9 percent, according to the Wall Street Journal.

Rep. PELOSI: Well, the health-insurance industry was raising premiums all along at a steady pace, and they're predicting that they might do that again. But this time, they do it at risk because they might not be able to participate in the exchanges later if they are frivolous in how they increase rates. So the American taxpayer and the American consumer have some leverage now that they didn't have before.

SIEGEL: But doesn't it stand through reason that if I'm now guaranteed no lifetime cap on benefits, and I could keep my children on to the age of 26 - couldn't do that before - and a prior condition doesn't exclude someone from a policy, shouldn't that cost more? Doesn't that inevitably cost more?

Rep. PELOSI: Well, good health represents a savings - prevention, wellness, innovation, which are all part of this health-care bill. I name a few provisions. What you haven't heard about is that the innovation, that prevention, it's about diet, not diabetes. It's about prevention, not amputation. So there's savings in earlier interventions, as far as health care. And the more people who are in the health-care loop, the sooner they are, the healthier they are, the lower the cost, the higher the quality, the better the access.

SIEGEL: HHS Secretary Sebelius wrote this - and you've alluded to it - she told the insurance companies that there would be regulations in which their request for increases, other increases, would be monitored, and she says we will keep track of insurers with a record of unjustified rate increases, and those plans may be excluded from health-insurance exchanges in 2014. I mean, does the potential threat of a sanction four years out, is that likely to protect a consumer in 2010 or 2011?

Rep. PELOSI: Yes, it is, for the follow reason: In 2014 - by then, 32 million Americans - more Americans will have access to quality health care. Some of them will be in the exchanges. Some of them in the exchanges will have subsidies for their health care. Do you not think that these insurance companies want access to that market of millions and millions more Americans? Of course, they do. But their access to it will be determined by their responsibility, their being serious about not increasing rates frivolously. And the secretary, per the legislation, has signaled to them that that is the case.

SIEGEL: Do you think that deterrence is working right now? That is, do you think we're seeing insurance companies showing restraint with 2014 and the...

Rep. PELOSI: Well, some are and some aren't.

SIEGEL: ...exchanges down the road?

Rep. PELOSI: But we have found out today that the bids are out now for -the CMS has put it - has told us that on average, the premiums are minus 1 percent increase, 5 percent increase in enrollment for Medicare Advantage. So all of the concerns about Medicare Advantage, I think, were dispelled by the fact of what came in, in the bids. Now, on the other hand, some of the insurance companies have said they're going to stop kids' own coverage in four states. Very irresponsible of them to do that. But the fact is...

SIEGEL: If it's irrespon - is there any sanction for them doing that, though?

Rep. PELOSI: Yes, the sanction is that they will not be able to have access to tens of millions of more consumers in the exchanges when the bill comes to full fruition. The consumer now has leverage. The U.S. taxpayer now has leverage. Before, it was all about the insurance company having it their own way.

SIEGEL: On the Bush tax cuts...

Rep. PELOSI: Yes?

SIEGEL: ...more than 30 House Democrats have broken with the White House and the leadership, saying that they could support extension of the Bush cuts, not just for the middle class, but for highest-income Americans. Has the time come to talk compromise on tax cuts for the rich to avoid a rebellion in the House, say?

Rep. PELOSI: No. Our members have not said they won't support a tax cut of the middle-class. They said they also want to have one for people at the higher end.

SIEGEL: Yes.

Rep. PELOSI: Our argument against that is that those tax cuts have not created jobs. They've increased the deficit. They will increase the deficit by $700 billion. They will take us into debt with countries like China in order to give a tax cut to the highest 2 percent in our country. Everybody under the Democratic proposal, the Obama extension of taxes for the middle-class, everyone across the board, up until the highest income, get a tax cut.

SIEGEL: But that tax cut would add $3 trillion to the deficit. If the deficit - if the impact on the deficit is bad for the highest-income taxpayers, isn't the impact on the deficit also bad for middle-class taxpayers?

Rep. PELOSI: No, for the follow reason. Middle-income taxpayers will use the money. Many of the people who will be getting this tax cut will inject it back into the economy, injecting demand into the economy, creating jobs. Tax cuts at the high end have not done that, as we can see in the Bush years. They just did not accomplish that. They're very expensive; they're geared to a small percentage of the population; they take us deeply into debt to countries like China. I'm a grandmother. I don't want to send any personal bills, or public bills, to my grandchildren - certainly not one to give a tax cut to people at the high end, which I would include myself to be.

SIEGEL: The people who study these things think it's possible the Democrats could lose the House in November - by no means a given, but possible. You know that.

Rep. PELOSI: Of course not.

SIEGEL: If your party does lose the House, would you step aside as leader of the Democrats in the House?

Rep. PELOSI: Well, first of all, I don't accept that premise in any way, shape or form. The momentum is with us. We are out there to dispel many of the misrepresentations that have been going on for nearly two years by the Republicans and the special interest - whether it's the oil industry, the health-insurance industry, the banks and their allies. And we are out there. Our members are great, articulate spokespersons for their point of view into their districts. And district by district, we feel very confident about the election. And we believe that six weeks from today, six weeks from Wednesday of this week, we will have no regrets but instead, we will have a great, Democratic victory.

SIEGEL: Speaker Pelosi, thank you very much for talking with us once again.

Rep. PELOSI: Thank you, my pleasure.

SIEGEL: Speaker of the House Nancy Pelosi. We spoke earlier today at the Capitol.

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