The White House
Office of the Press Secretary
Press Briefing by Press Secretary Jay Carney, 11/05/2013
James S. Brady Press Briefing Room
1:01 P.M. EST
MR. CARNEY: Good afternoon, everyone. Thanks for being here at your White House briefing. I do not have any announcements to make at the top, so we can go straight to questions.
Q Thanks, Jay. Democrats and Republicans on the Hill are proposing legislation that would make good on the President's promise that anyone who likes their health care coverage can keep it, even if it offers fewer benefits than the law requires. Senator Landrieu has a proposal like that. I wonder how -- is there anything wrong with that idea? Would the President support something like that? Doesn’t it live up to his pledge?
MR. CARNEY: Well, here's what I'd say, Jim. We're focused on implementing the Affordable Care Act. We're focused on fixing the problems that have caused a lot of Americans consternation when they're dealing with the website. And we're making sure that millions of Americans who are looking for information about their health care options are able to get it, and that they're able to register and enroll.
When it comes to that provision within the law that grandfathered in plans that existed before the Affordable Care Act was passed, that is obviously what the President was referring to. He was also referring more broadly to the general principle and promise of the Affordable Care Act, which is that if you're one of the 80 percent of Americans who is insured or covered through an employer plan or through Medicare or Medicaid, or the veteran's administration, there is no change for you except for an increase in benefits that everyone receives as a result of the Affordable Care Act.
If you're one of the 15 percent of Americans who are uninsured, whose only recourse for health care is the emergency room, then you have nothing but better options because you have available to you potentially free or very affordable health coverage -- free if it goes through Medicaid, or affordable options that did not exist for you before.
If you're one of those Americans in what makes up only 5 percent of the population who currently receive -- get coverage of some kind through the individual market, and had a plan before the law passed that has not been changed by your insurance company, hasn’t been canceled by your insurance company, downgraded by your insurance company, you can keep it. It's written into the law and was explained by Secretary Sebelius when the rule associated with that provision of the law was published in 2010.
However, if you are in the individual market and your insurance company changed your plan, downgraded it, your insurance has to meet the basic standard set by the Affordable Care Act. And what our job is -- and the failure of the website to function effectively has made this job more difficult -- is to make sure that those Americans, that portion of 5 percent of the population, are getting the information they need to know that they can avail themselves, half of them, of tax credits that will make their insurance cheaper than it otherwise would be; that in all situations for them, the insurance options they have available to them is better, more quality coverage than what they're getting now.
And as the President said in Boston and said again last night, there will be a portion of them, a smaller portion of those individuals who will pay higher premiums, at least in the front end. And the President talked about that in Boston and talked about it again last night.
But we’re focused on all these aspects of getting this implementation on track so that Americans across the country are able to get the benefits that the Affordable Care Act promises.
Q While those percentages might be small, the actions represent millions, millions of people who are getting these notifications. And the Chief of Staff, Denis McDonough, met with some insurance CEO -- company CEOs today to take issue with that, with these notices, and presumably because they’re not providing enough information to customers.
So I’m wondering -- clearly this is in the forefront of the White House -- why wouldn’t the legislation, again, that’s being proposed, that would simply extend -- in one case, that it would extend it through 2014 -- I think that’s a House Republican proposal -- that whatever your plan is, you can keep it?
MR. CARNEY: Well, I haven’t reviewed or seen an examination internally on any ideas that people have put out about legislation, so I don’t have a response to a specific proposed piece of legislation.
I think that the broader principle is that if you’re going to assert that insurance companies can continue to offer substandard plans, bad apple plans, for example, that do not provide hospitalization or have carve-outs that exempt from coverage the very chronic condition you may have -- often in a way that the purchasers of this insurance don’t even know -- that that undermines the fundamental promise of the Affordable Care Act, which is that everyone in America should have access to affordable, quality health care coverage.
But again, that’s not in response to any specific idea that people are bandying about on the Hill. I think that that is the explanation for the broader approach, which is that back when the law was being written, and the provision that the President insisted be part of the Affordable Care Act that allowed for the grandfathering in of existing plans on the individual market -- so that if you had that plan and you wanted to keep it, even though it was substandard, you could -- that you couldn’t apply that hypothetically to plans that did not exist, because basically you would be undermining the central promise of the Affordable Care Act, which is a sort of bottom baseline of coverage that everyone should enjoy -- which means that mental health services are covered, preventive services are covered, there are no annual or lifetime caps; there are all sorts of benefits that are basic to every plan offered under the Affordable Care Act. You can’t be charged double if you’re a woman, which was something that insurance companies regularly did because they could.
And it's important, as we have this discussion, that we remember that the status quo ante here -- the world back to which many critics want us to go -- is a world in which insurers have that power to say that your relative who has a preexisting condition either has no chance of getting coverage or is going to be charged so much that he or she can't afford it.
So the whole here is important to look at, even as we talk about slices. The whole is based on a principle that there ought to be affordable, quality health care coverage available to every American.
Q Is the President, though, troubled by the anecdotal evidence that these notifications are going out? And it's ample evidence, that they're going out.
MR. CARNEY: Well, there's no question that the notices are going out. And he's troubled by the fact that the website has made it a lot more difficult for those Americans to get the information that they need so that they can know, for example, that they qualify for tax credits that will reduce costs for them. They can get the details on the insurance plan options that they have and find out that their coverage is significantly better under these options than under their current plans. They can find out if they qualify for Medicaid. A million of these individuals are estimated to be qualified for Medicaid because of the Medicaid expansion provision within the Affordable Care Act. So that's a significant number of those currently on the individual market.
So, yes, he is frustrated by that. And we are committed to do a better job of getting that information to the American people who deserve it. And there's no question about that. When it comes to -- some of these anecdotes, as we've discussed, turn out to be a little different upon closer inspection, in part because of the problems I just described: If the individuals aren't getting the information they need, they often don't know what the future looks like for them.
So, for example, the I think very sensational report last week that focused on a woman from Florida and her existing insurance coverage and her concern that she couldn't keep that plan -- a little reporting, a little more information, and Consumer Reports did a story on this, that the coverage she had was so-called "junk" coverage. There was no coverage at all. There was no protection whatsoever from financial ruin if she got sick. It didn't even cover hospital visits. So it's important -- and this is also on us -- that Americans who are affected by this, that that portion of the 5 percent of the population that are affected by this get information about their options so that they can make choices that they haven’t been able to make before, and they can better understand that the coverage they’re going to get is superior; that they may qualify for tax credits that reduce the costs of their coverage; that most of them will pay the same or less for better coverage.
This is all important, and it’s all on us, and that’s why we’re working every day to get that information to the Americans who need it.
MR. CARNEY: Roberta.
Q This morning, Marilyn Tavenner told the Senate hearing that the administration is working on a plan to reach out to these people who have had their plans canceled. What is that plan?
MR. CARNEY: We’re working on it. No. (Laughter.) I was not able to watch all of her testimony, so I’m not sure of all the specific things that she said. I think she’s referring to the general effort underway here to make sure that everyone out there who needs this information is getting it.
The marketplaces are set up for that universe of people who don’t get insurance currently through their employers or through Medicare or Medicaid, and who may be eligible now for Medicaid because of the expansion in those states that accepted it, who are looking -- are uninsured but haven’t -- but now have the possibility of getting quality, affordable health insurance through the marketplaces.
So I don’t have a specific plan to describe to you beyond the imperative that we get that information to everyone who needs it. And that’s --
Q So it’s not some sort of specific outreach to these people?
MR. CARNEY: Well, I would refer you to CMS and HHS. They may have more detail on Marilyn Tavenner’s testimony in their briefing. But it’s part of an overall effort to fix the website, to make sure that these other options that the American people are aware of, the other options they have available to them for getting information through in-person consultations or through the call-in center, or they can also apply by mail, as you know.
And they can go on the website now. I mean, there are folks obviously who may have experienced real difficulties in the early days after the launch, who, if they go on now, will find that while it is still below where we need it to be in terms of functionality, it’s better than it was, and they are able to access important information about the plan options available to them.
So this is an all-hands-on-deck effort to make sure that Americans who need this information are getting it.
Q Can you tell us more about the meeting that Denis McDonough had with the insurance companies -- who was there and what he was telling them or asking them to do?
MR. CARNEY: Sure. I meant to get into this in response to Jim’s question.
This morning, White House Chief of Staff Denis McDonough met with a group of the nation’s largest health insurers to discuss the ongoing efforts to improve healthcare.gov so that it works as effectively as possible for consumers and participating insurance companies. During their meeting, Mr. McDonough updated the issuers on the progress the tech teams at CMS are making to fix issues with 834s and direct enrollment -- two of their top priorities. I think most people now know what 834 refers to.
He reiterated the administration’s commitment to finalizing these fixes as quickly as possible and working to open new doors to enrollment. Mr. McDonough asked for input from the attending insurers on how CMS’s fixes have affected their enrollment experiences on the ground. He highlighted encouraging new survey data showing there is great interest among young Americans in purchasing affordable health insurance, many of whom will have access to a range of options at a very competitive price.
And finally, he emphasized the need for all involved in the marketplaces, including the administration, issuers and other stakeholders, both federal and private, to ramp up communication and education efforts to consumers who have received or might receive letters about their individual market plans changing.
And that goes to what we were talking about before. We need to ensure that that portion of the 5 percent who might be getting these letters are made aware that they have a pretty broad array of options available to them. The letters, depending -- it’s different for each issuer -- may include an effort by the insurer to, understandably, retain the business of the individual and might point out the options that that insurer has, the plans that that insurer has -- may even suggest one -- but would not necessarily include information about whether that individual is qualified to receive a tax credit, which could reduce significantly the premium that he or she might pay; would not, obviously, include information about plans their competitors are offering. And in state after state after state, there are more plans available and there is more competition because of the Affordable Care Act.
So we need to get that information to the American people.
Q So he’s telling them to give them that extra information?
MR. CARNEY: No, no, he's obviously -- he's saying that we all need to do the best we can in getting information that consumers need. I think obviously for insurers, it's in their interest to make it clear to their customers that they have offerings for them that meet the standards of the Affordable Care Act, and also that they may be eligible for credits. I'm not suggesting that private insurance companies market their competitors' plans at all. I'm simply saying that there is a -- one of the obvious benefits for insurers of the Affordable Care Act is the vast increase in the number of people purchasing insurance that it will bring about.
And there's an interest by insurers in making sure that they compete for that business, and that’s a good thing. It helps keep prices manageable. We've seen, since the passage of the Affordable Care Act, the lowest growth rates for three straight years that we've seen in 50 years. And I would remind folks that opponents of the Affordable Care Act during the legislative process assured the country that growth rates that were already huge in the health care market would explode as a result of the passage of the Affordable Care Act. But the opposite has happened, and that has been a good thing.
So if you're a company out there that was projecting costs five years ago based on the expected rate of growth in health care costs overall, you've welcomed the news that those costs have come in so much lower than expected, because that affects, positively, everybody's bottom line, including the federal government's bottom line -- because when the cost of health care goes down or the rate of growth slows, that saves taxpayers money, saves the government money, because we administer, obviously, Medicare and Medicaid.
Q Last night at the OFA event, the President said, "If you have or had one of these plans before the Affordable Care Act came into law and you really liked that plan, what we said was you could keep it if it hasn't changed since the law was passed." But that’s clearly not what the President said repeatedly over and over again in selling this plan to the American people. How does the President account for that? Why is he adding these caveats that he did not issue to the American people years ago? And why doesn’t the President just admit he misspoke or just should have been more complete in his comments at the time?
MR. CARNEY: Well, thank you for the question. I just want to be clear: The President was referring to the law and to the fact that the law was written in a way -- and everybody who closely covered the drafting of that legislation knew it was written about -- that the grandfathering clause was in the law, and he was referring to the implementation of that law through the rule process. When the rule was issued, Secretary Sebelius and others spoke to the press about it, specifically about the fact that not everybody -- that if insurance companies changed their plans or canceled their plans, they would give up the opportunity to grandfather those plans in, in June of 2010. And there was a fair amount of coverage of that in major newspapers.
So the principal --
Q The President didn’t use those words.
MR. CARNEY: I didn’t say he did, Jim. He was referring overall to the administration and the law itself. Look, the provision within the Affordable Care Act was the manifestation of the President’s promise that if you had a plan that you liked, you could keep it. But he didn’t say, if your insurance company cancels your plan and gives you something else that's worse, you can keep it. He said that if you have a plan that you like, you can keep it.
Now, I understand --
Q Does the President acknowledge that that pledge that he made over and over again -- if you like your plan, you can keep it -- does he now acknowledge that that was a mistake, that that was problematic, that he shouldn’t have said it?
MR. CARNEY: I'm going to -- the President was --
Q Just a yes or no -- do you know whether or not the President has said that to you or --
MR. CARNEY: Well, it’s a little more complicated than that. I can tell you that the President was making a statement about --
Q But it’s not complicated, Jay. He used --
MR. CARNEY: Give me a chance, Jim. I'll let you ask a lot of questions, I promise.
Q All right.
MR. CARNEY: But the President was making a statement about the overall promise of the Affordable Care Act: 80 percent of the country is covered by their employers, by Medicare, Medicaid, or the VA. The only changes for them are positive ones -- increased benefits because of the Affordable Care Act. Fifteen percent of the country, uninsured, now has access to affordable care that they did not have before. Five percent is on the individual market. Of that 5 percent, if you had a plan and your insurance company didn’t cancel it, you could keep it.
I acknowledge that we need to, as I just said, make sure that folks who fall in that 5 percent and had their plans canceled by their insurers in the past three years, that we need to do a better job of getting information to them so that they know what their options are, and they know that they will, without question, have higher quality insurance because of this than they currently have.
Q Let me try it a different way.
MR. CARNEY: Look, one more bit of this and then I'll take another question. They will have the possibility of qualifying for credits that will reduce the cost of their insurance -- this better insurance that they get.
And don't forget, as Dan Pfeiffer said on Sunday, if the President didn’t mean to keep that promise, why was it written into the law? And the fundamental issue here is the broader promise of affordable, quality health insurance for every American -- access to it.
Q So if the President could go back, he would use the same words again?
MR. CARNEY: Well, the President, as awesomely powerful as the office is, can't go back in time. And what the President is focused on is what we're all focused on, which is getting this right for the American people and getting it right for everyone so that the benefits of the Affordable Care Act, the improvements in the coverage that everyone will enjoy and the broader benefits for our economy because of the slower rate of growth and health care costs come about and come into being.
And there's no question that this rollout has not gone as smoothly as we had hoped. And there's no question that the website has caused a lot of problems for Americans trying to get information about the options available to them because of these marketplaces. And it's a reality that because those marketplaces are designed for a segment of the population, that the segment of that segment that are finding out that their insurance plans are substandard and have been changed since 2010 and don't meet the minimum benefit requirements of the Affordable Care Act, that that existing coverage is discontinued on December 31st.
And we have to make sure that they're getting the information they need so that they can enjoy the benefits of the Affordable Care Act: better coverage, tax credits, minimum benefits, including free preventive care that will have a positive effect for all of us. So even the folks the President talked about both last night and in Boston, who will initially pay higher premiums, there is a longer-term benefit here to them and the broader market when they're receiving free preventive care, they're receiving some of the benefits that are minimally required, because that goes to their long-term better health and forestalls more expensive care in the future.
Q But you said the President meant to keep this promise, that this is a promise not kept. Is that right?
MR. CARNEY: Jim --
Q Words are words. The President's words are important, this pledge is important.
MR. CARNEY: Look, I'm not going to argue with you about --
Q I just want to get the record straight.
MR. CARNEY: The President was speaking very specifically about the broader promise of the Affordable Care Act. And there is no question that of the portion of the 5 percent who currently participate in the individual market, that some of them are finding out that their plans, because their insurance company pulled the rug out from under them sometime in the last few years, aren't grandfathered in.
The promise was that -- and it's written into law, and it was specifically spelled out in the rule that was issued as a result of the law, and I can point you to the stories written about it -- was that if insurers canceled your plan, they couldn’t come back and say, well, I canceled the plan that qualified for grandfathering, and I'm going to give you something even worse, and then say that the Affordable Care Act made me do it.
That’s not what happened here -- because every insurer who offered a plan on the individual market prior to the passage of the law could have maintained that plan, could have continued to offer that plan, and as long as it wasn't significantly changed it's grandfathered in. For some individuals who enjoy that benefit, they may still look at the options available to them through the marketplace and find that they'd rather have better coverage than what their current plan offers.
But the fact is, we were able to write into the law a clause that grandfathered in existing plans. There are those who --
Q That was written into the law. But has the President expressed to you or anybody in this White House that maybe he should just come out and say that he screwed that one up?
MR. CARNEY: Jim, I can just give you the answer that I gave you, which is that the President spoke about the broad promise here. He spoke about the absolute need to make sure that quality, affordable health care was available to all. The fact that -- the provision in the law was the manifestation of the assurance that if you have a plan you want to keep, you can keep it. Insurance companies that chose to strip away benefits from existing plans in the interim, that canceled existing plans in the interim, they took away that grandfathering opportunity. And that’s a reality.
And it is on us -- and let me be clear, I am embracing the responsibility that the administration has and that everyone involved in the marketplaces has to make sure that those individuals are getting the information they need and are finding out what their options are, and that it is made clear to them -- as was, I think, now made clear to that woman in Florida that her options are far superior to her existing circumstance -- and that many folks might qualify directly for Medicaid; others will get tax credits that assist them in paying their premiums. And all of them will get better coverage than their getting under the existing individual market, which, as I've said in the past, is like the Wild West. It's the place where the worst practices are engaged in, and where those who insist that we ought to -- who tried over the years to repeal the Affordable Care Act -- we ought to go back to that status quo where the insurance companies controlled what kind of coverage you would get, what conditions they would cover, they would place arbitrary annual limits on what they would spend for your health care -- annual and lifetime. And all of that has changed, and it has changed for the better.
Mara, and then Major.
Q Starting in December, when the website is fixed, a big push to get young people to sign up. I mean, I guess there is really no point telling them to go there if they can't access it. You said one of the problems is even if they're being canceled --
MR. CARNEY: No, that's a good question. The answer is, yes, but there has been a big push and all along that's part of the education process of letting young Americans know that these options are available to them. And, again, I think I cited this when talking about Denis's meeting with insurers. There's data out there and surveys out there that show young folks are interested in purchasing affordable insurance, which sort of busts one of the myths out there that young people actually aren't interested in buying affordable insurance. And so it's our job to make sure -- and everybody who is part of this effort -- to make sure that the information they need is available to them.
Now, as I said before and I've tried to say all along, the fact that the website is not functioning as well as it should doesn't mean it's not functioning at all. There are people who are -- you can get information on it, you can sign up and enroll on it, but there are too many troubles, too many problems, too many bottlenecks and glitches. And until that's resolved, we'll have challenges associated with the website. But the effort overall continues. And you're absolutely right that making sure young people know what options are available to them is a key component of the Affordable Care Act.
Q Well, I guess everybody always expected older, sicker people to be the first people to sign up. Obviously, they have more incentive to want it. But there are reports that the initial enrollment is more skewed to older and sicker people than insurers even thought it would be. So they're getting even less young, healthy people than they thought they would get and much less than they need to make the whole system work.
MR. CARNEY: The percentages are not skewed as far as we're concerned. I think that some of the estimates were based on Medicare Part D, which was obviously a benefit directed at older people alone and not younger people.
And what Massachusetts tells us, the more direct, analogous experience tells us is that young people come in very late. People in general come in very late. Those who in Massachusetts qualified for Medicaid coverage or other kinds of coverage that did not require the payment of a premium came in in fairly large numbers right away. Premium-paying customers didn't come in until late. And as we've cited in the past, in Massachusetts, only 123 folks came in in Massachusetts in the first month.
And for those of us who either have kids -- or some of you who are young enough to remember what you were like at that age -- it has always been the expectation and the case that younger Americans will wait until the last minute before they make a decision and apply and enroll.
So our expectation was always that that would be the case, and we've tried to telegraph that in general about enrollment and the crescendo that we expect. There's no question that the problems with the website have exacerbated the trend, which is why we have to work all the harder to make sure that it gets up and running, and that we do everything we can to make sure that folks are applying and enrolling.
David. I'm sorry, I did say Major, then David. Major, sorry.
Q In her opening statement at the hearing today, Barbara Mikulski, a friend of this White House, a supporter of the health care law, said that she believes and fears that the law is facing a crisis in confidence because of the website, because of cancellation notices. And she even mentioned sticker shock that some people are encountering as they look at the difference between what they had and maybe the new premiums. Do you believe that she is on to something that this law confronts -- and this is someone who is supportive and wants this law to work and is a friend of the President's -- that this law confronts a crisis of confidence?
MR. CARNEY: The President shares Senator Mikulski's frustration with the problems that we've seen with the rollout, which have been focused on the problems that the website --
Q Although she mentioned others.
MR. CARNEY: No question. But I think some of these other problems are exacerbated by the fundamental problem that we've had with the website. For example, when you get a letter -- if you're one of that slice of the 5 percent who received a letter, but you haven't been able to go online and you didn't know that you could call and find out -- but you haven't been able to go online to get information about what plans are available to you and all you know is perhaps what your insurance company told you, which was just the premium costs on a potential alternative without any information about whether you qualify for a subsidy, it may come as concerning news to you, because that's all you know at that point, and you don't know the fact that you may well qualify for a subsidy; half of that population will. You may qualify for Medicaid, expanded Medicaid when you didn't in the past, and that will be welcome news for roughly a million of those Americans.
So, look, there's no question that the problems --
Q That's not alarmist rhetoric is sort of my question.
MR. CARNEY: Well, no, I don't think so. Look, we are focused on getting these things right. And the fact that they haven’t been right -- and this stems from principally the website -- has caused obviously concern here. And that's why we've dedicated the resources we've dedicated to fixing the website, and improving the communication and education effort so that people understand that when they see a report about someone who got a letter and is now told that -- or believes -- and the reporter reports that he or she is going to pay twice or three times as much as they paid in the past, but they don’t hear that the plan they used to have was terrible and really didn’t cover them, and offered them no financial security, and they don’t hear that those letters are only being sent to a fraction -- a very small fraction of the population, that it doesn’t affect you if you have Medicare or Medicaid, it doesn’t affect you if you’re covered by your employer, that it creates alarm.
And we need to -- we’re working on making sure that we address these problems, both at the website and in the communication of the options to those Americans who need to know what their options are.
Q Let me ask you a philosophical question about one of the characterizations you’ve made about the law, and the bad insurance that people may have had before. Is it possible, and does the White House understand how someone in the insurance market, the individual market, could say, “You know what, the White House may believe I have a crappy insurance policy, but I like it, and because I have an orientation toward either liberty or individual personal choice, I’d like to keep it, or I think I know as much if not more about my own needs and my own insurance coverage as the White House, and I may actually not be comfortable with the administration telling me I have a crappy insurance policy and they know more about my health care needs than I do”?
MR. CARNEY: Well, I would say a couple of things. One, the fundamental philosophical question you’re asking was the one that was debated when health insurance reform was debated -- not just when Obamacare was passed, but every time that health insurance reform has been discussed and legislated and Congress has attempted to pass it over a century.
And so when it comes to should there be minimum benefit standards, that is obviously the President’s view, the administration’s view, and that was foundational to what the Affordable Care Act provides. It was what the battle in Congress was about, and it is a law that passed and the President signed and the Supreme Court upheld, and it was a focus of a presidential election in 2012 that the person who is most closely associated with the law won.
But obviously that didn’t mean that once that election was won or the law was passed, that all opposition to it would cease to exist, that all philosophical opposition to or ideological opposition to the idea that there should be minimum standards of insurance.
I mean, it’s not entirely different to somebody who is opposed to wearing a helmet in a state where there’s a helmet law for motorcyclists, right? You can be ideologically opposed to it. You may think it’s wrong, that it’s government overreach. But the legislative body that passed that law disagreed and has been elected or appointed. Or, for example, basic car insurance that is a requirement in state after state after state -- there may be individuals who say, “You know what, my conception of personal liberty says that I’m a safe driver and I shouldn’t have to buy insurance.” Well, the decision is made by --
Q Okay. But I think you would acknowledge that there is a difference between not wearing a helmet and never buying insurance, and having insurance that you’ve actually sorted out, looked at competitively. You may have done some shopping. You may have actually run the numbers for yourself or your family, and said, you know what --
MR. CARNEY: Well, no, -- look, but you’re talking about a philosophical -- if that person had that policy and it was grandfathered in, that person, for philosophical, ideological or other kinds of reasons, may just keep it even if other options are available to him or her. But the broader argument about whether you agree or disagree that there should be baseline standards for insurance coverage is one that goes to the heart of the debate in the beginning, and obviously the President feels there ought to be.
He feels very strongly, and a lot of people feel very strongly, that insurance companies that take advantage of and have taken advantage of, for years, individuals in this market who have so little recourse by charging women double -- I mean, my guess is the person here is not a woman, because if a woman wanted to say, “I like paying double, because my insurance company is taking advantage of me and my gender for years or decades,” that would be an odd position to take. But if she had that policy before 2010 and wanted to keep it and wanted to pay double for worse coverage, she could.
But it is absolutely the case that the President believes there ought to be minimum standards of coverage. And that philosophical and ideological debate was engaged. And I’m sure it won’t go away because I’m sure the House will, at least a couple more dozen times, vote to repeal.
Q As you’ve learned, the language from this building and this podium is very important as this health care debate goes forward. Last week, what we were told is that the website would be fully operational for most users by the end of November. On the CMS call yesterday afternoon, that was amended slightly to it will be vastly improved by the end of November. I would like for you, as best as you’re able to, set the benchmark that the President has set for what this website will be in terms of its functionality and usability by November 30th.
MR. CARNEY: I think the point that -- and I would point to Jeff Zients and CMS and the President and others -- is that what we believe, and what Jeff and those who are on the ground addressing the problems and getting them fixed, is that by the end of November the site will function effectively for the vast majority of the American people who use it. What we can’t obviously guarantee is that nobody will experience a glitch ever again come December 1st. But for the vast --
Q But it sounded yesterday on the call as if they were sort of dialing that back --
MR. CARNEY: I’m not sure, I didn’t listen to the call. And you could ask them for a clarification. My understanding is that that --
Q But I mean, the President has set the standard on this.
MR. CARNEY: Right, and the standard has not changed. The standard has not changed.
Q Okay. One other thing on the insurance companies -- because there was a lawsuit filed yesterday in California by two Blue Cross consumers who don’t believe their insurance company was candid enough with them about alternatives available to them; they just sent them a cancellation notice. Is that a legitimate grievance that this administration believes consumers have as these cancellation notices have gone out? And was that something directly that Denis brought up with the CEOs?
MR. CARNEY: Well, the readout --
Q I'm not asking you to comment on the litigation.
MR. CARNEY: Yes, I wasn't in the meeting that Denis had, so I don’t have more on the specifics in the conversation than what I just provided earlier. And I'm not aware of a lawsuit and wouldn’t comment if I were.
But, in general, I think that what's -- it's in everybody's interest here that Americans in this market get all the information that they deserve about their options. So we're working with every interested party to make sure they get that information. I don’t know the specific cases here. I think that --
Q But is the administration concerned that insurance companies are not being clear enough with consumers about their options?
MR. CARNEY: I don’t have that specific concern to report. I think that what is definitely the case is that a lot of Americans out there who have gotten these letters -- again, this is the slice of 5 percent of the population that have gotten these letters -- were not initially aware of their options. And again, we accept responsibility for a portion of that because the website wasn't working. The easiest way for them that they knew about, potentially, of finding out more information was filled with obstacles because of the poorly functioning website.
Now, we have -- part of our effort has been to provide other avenues for these Americans to get information through call-in centers or in-person centers or downloading an application and sending it in by mail. And we've improved the website so that they can get more information from the website.
So what I said at the top remains, that the fact that a lot of those Americans aren't getting the information they need and may, therefore, be concerned about what options they have is partly on us, at least partly on us, and we accept that responsibility and we're working to fix it.
Q Last topic -- on the TSA shooting at LAX. The administration obviously has had some time, perhaps the President has, to digest all the facts there. Any new thoughts about a different type of approach to TSA security having maybe a companion police force within the agency? You probably don’t have a conclusion on that. And do the facts of this case renew in the President's mind, and will we see any demonstration of this in the near term, about the need for gun control?
MR. CARNEY: I haven't had a discussion with him about this related to the broader need for common-sense measures that reduce gun violence, which remains an objective of his. When it comes to how the TSA operates, certainly my understanding is that TSA is there working every day to ensure that passengers are safe on their flights and that airports have security provided by local law enforcement.
But I haven't been part of discussions; maybe DHS or TSA can fill you in on their views in the wake of that. What I know the President believes is that the TSA employee who was killed was serving his country and making Americans safer, and those who fly in and out of American airports safer. And he deserves -- his family deserves our prayers because of his sacrifice.
Ed. I’m sorry, I said David after Major. It was so long ago, that I --
Q Back to the fraction of a fraction of 5 percent -- a fraction of those people are going to have to pay more. It may be a better policy, but they’re going to have to pay more. We started to hear what the President is going to say. What would the President’s message be to somebody who, say, paid $1,500 a year and now is going to have to pay $2,000 a year? I mean, they’re going to have to pay more out of their pocket, which is not what the President told them.
MR. CARNEY: Well, I'm not sure which statement from the past you're referring to. The fact is the President spoke yesterday and in Boston about a portion of those folks who, if they’re on the individual market now and their plan isn't grandfathered in, it’s because their insurer changed the plan and downgraded it, made it even less compliant with the Affordable Care Act. So let’s remember that, and when you report that, I urge you to make that clear.
The fact is, as the President said, a subsection of that slice will potentially pay more because they earn too much to qualify for either Medicaid or a tax credit, and they’re getting substantially better coverage than they currently have. And the cost on the front end will be higher for that portion that might be paying higher premiums -- again, a slice of a slice of 5 percent. But the overall cost for them will potentially be lower because they have better coverage, which will improve their health outcomes and potentially reduce their overall health coverage.
Q That's not what the President told them two years ago.
MR. CARNEY: I'm not sure what it is you're --
Q Well, if you have your insurance and you like it -- and you said --
MR. CARNEY: But, David, you're confusing two things.
Q No, I'm not confusing --
MR. CARNEY: The President never said that somebody who goes without insurance but can afford it would be paying less or the same -- i.e. nothing. If you're somebody who -- if you're 30 and you're young, invincible, and maybe you're making decent money but you just decided not to buy insurance, yes, you're now required to buy insurance. So obviously, unless you qualify for Medicaid, even if you're paying 50 bucks a month -- and a lot of young Americans will pay that little -- that you’ll be paying more.
So he never said that everybody would pay less. If you're saying that's what he said, I don't think you could find that.
Q And you said that these insurance companies that have stripped these on, these are junk policies -- these insurance companies were offering some coverage to these individuals who found that that was what they wanted.
MR. CARNEY: They found that that's all they had.
Q But that's what they wanted. A woman who doesn’t want to have children doesn’t have to have maternity care, doesn’t need insurance for that. Now she has to have it. She couldn’t keep the policy that she had and she liked.
MR. CARNEY: Well, David, this goes to the discussion that I just had with Major. We absolutely accept the charge that we believe there ought to be minimum standards of coverage -- preventive services, mental health services, maternity care, a ban on --
Q But --
MR. CARNEY: Hold on -- a ban on lifetime -- because it’s not just -- you’re not -- there isn’t a plan out there that a female American purchased on the individual that doesn’t meet -- that meets all of the minimum standards except for not applying maternity care. You know that doesn’t exist. These plans overwhelmingly have carve-outs, they have caps, they don’t cover hospitalization. This is not -- this is an area of the market that is not one that we want to emulate or expand if we want to improve health care and health outcomes in this country.
But going back to my basic point, yes, we believe, and the Affordable Care Act makes law, that there should be minimum standards for basic health care coverage, health insurance coverage. And if you had a plan that did not meet those minimum standards and your insurance company hasn’t downgraded it in the interim, you can keep it. It’s grandfathered in forever if you want to keep it and choose not to avail yourself of other options and better coverage.
But look, I think it’s worth studying -- if you’re going to do reporting on the individual market -- studying what we’re talking about here. And one of the reasons why that area of the insurance market so desperately needed reform is because it was the area where insurers could so easily take advantage of consumers because consumers had so few options. They had a chronic preexisting condition. They had maybe one carrier in their area that could offer them coverage. They did not have the options that are now available to them through the Affordable Care Act.
Q You’ve said that there is great interest among the young Americans with this new survey data. Whose data is that? What is the data? And will you share it with us?
MR. CARNEY: Yes, it’s public. Let me see if I can find it here.
Q Did something come new from the CMS in the last couple of days?
MR. CARNEY: I have a lot of tabs here in my -- under health care, shockingly. Well, there is a new Kaiser report. It’s the Commonwealth Fund, I think. We’ll get it for you. I’ve got it in here. I’ve got a lot --
Q Anything from CMS of late?
MR. CARNEY: This is not a -- this is an outside, not a CMS -- this is an outside, nongovernmental projection, not ours.
Q Jay, obviously the words the President said three years ago have been picked over many times. But what about what he said just over a month ago? September 26th, in Maryland, he had an event right before the actual rollout, and one of the things he said was, “If you already have health care, you don’t have to do anything.” You can at least say that was not true, right?
MR. CARNEY: Look, I, as I said last week, accept that communications are challenging here. The President -- I mean, look, you have to remember that the Affordable Care Act promises --
Q But it’s not true. He didn’t say yes. It’s not true.
MR. CARNEY: Look, Ed, I’ve addressed this question repeatedly. What I can --
Q But did he just not anticipate that cancellation letters would come out? I mean, you’ve been bashing the insurance companies and saying they kick people off all the time anyway; we knew that even before the Affordable Care Act kicked in. So how did that get in the President’s remarks? Nobody here at the White House knew that, in fact, if you have health care, there could be changes?
MR. CARNEY: What the President was referring to was the broader promise of the Affordable Care Act, that if you’re on Medicare or Medicaid, if you, like probably most people in this room, have insurance through your employer, if you’re a vet and you get coverage through the VA, you don’t have to do anything. And the proof of that obviously is that if you’re uninsured, you now have available to you options to purchase insurance that you never had before. And if you don’t qualify for Medicaid but you might qualify for a subsidy, you have to look at your options and make your choices.
But our focus, Ed, is on implementing the law and getting these benefits to the American people.
Q But part of implementing it is communicating with the American people about if you have this plan or you have that plan, how you deal with it. And here is the President of the United States, a few days before the actual launch, saying something that just wasn’t true, right?
MR. CARNEY: Well, Ed, look, I can -- I accept, and I’m not going to argue with you, that there’s a lot of focus on a slice of 5 percent of the population. And part of that focus, and the consternation that’s been caused by the letters that have gone out, is due to the failures of the website that have meant it’s harder for these individuals to find out and be reassured by the fact that they have options for indisputably better coverage, and in many cases, most cases, coverage that’s better for the same cost or less.
So that’s on us, and I accept that. And --
Q Okay. But when you keep saying this is only 5 percent, and you keep -- earlier in the briefing, you said, I understand there were mistakes with the website, we own that, et cetera, et cetera -- isn’t this more, though? Isn’t it about the -- it’s been said the President’s words matter, but also his credibility with the American people. Even if it’s only involving 5 percent of the American people, it’s still millions of people. Doesn’t his credibility matter in what he communicates?
MR. CARNEY: Again, it’s a portion of the 5 percent, just for precision’s sake. But what I can tell you is that the President campaigned on, argued for, signed into law the Affordable Care Act. And what he’s focused on when it comes to what he believes is right for the American people, what he ran on, what he ran for reelection on, is on health insurance reform that sets minimum standards of coverage that allows for access for every American to quality, affordable health coverage -- a reform that when fully implemented will reduce our deficits significantly over the long term, and will live up to its promise of reducing overall costs. And we’ve seen that already.
And again, the opposite has happened to what critics at the time said would happen. And it kind of reminds me of critics in 1993 swearing that the Clinton economic plan would bring about economic ruin, and in fact what happened after that was the largest peacetime expansion ever, and substantial economic growth and job creation. It’s funny, if you go back and ask the Republicans who made those claims, they don’t really want to talk about what actually happened.
Well, what has actually happened here is that health care costs have slowed to their slowest rate of growth in half a century. That’s a significant thing for something that’s such a big part of our economy. For employers, for employees, for the government, this is a big deal, and the Affordable Care Act is part of the reason why that’s happening. And the President’s focus on living up to the promises he made is ensuring that that affordable health care coverage, that quality health care coverage is available to Americans across the country.
Q A very quick question.
MR. CARNEY: I promise I will move back after this.
Q The head of the CMS, Marilyn Tavenner, said today that the administration is going to release the health care, the ACA numbers sometime next week. First of all, do you know when that will be specifically?
MR. CARNEY: I don’t have a date. We’ve said mid-November, so I would refer to her and to CMS.
Q Sure. Has the President seen what the numbers are that will be the first numbers to be released yet?
MR. CARNEY: No.
Q I know you have a lot to --
MR. CARNEY: I mean, the President gets updated regularly. I think the point we’ve made all along is that we want to make sure that we’re providing the most accurate data available. And because of the ways in which this data is coming in, and because of some of the problems we’ve had with the website that have affected the collection of accurate data, we want to -- mid-November is when we’re going to have the quality data available for public release.
Q On a separate topic, noting that you have a lot of different tabs in that briefing book, I want to try to get to a different one if I can quickly. The President, during today’s event that the pool wasn’t able to go to but we could watch remotely, noted that he was watching the Bears-Packers game last night. We know he’s a die-hard sports fan. The big football game -- the big football conversation lately has been regarding a player from the Miami Dolphins who was suspended indefinitely for bullying one of his teammates on the offensive line.
This White House has been strong advocates in opposition of bullying. I think it was March of 2011, the President and First Lady even held a bullying prevention conference here at the White House. Is the President aware of the events that took place within the Miami Dolphins organization? Does he have any opinions about bullying? As he said then, “It’s important to dispel the myth that bullying is just a harmless rite of passage.”
MR. CARNEY: The President strongly believes that, as do the First Lady and the Vice President and Dr. Biden. I think all of them participated in the anti-bullying effort that the administration was involved in.
I have not had a conversation with the President about the story involving the Miami Dolphins, so I can't report to you his thoughts on that. I'm confident he is aware of it, but I just don't have a response from the President on it.
Bloomberg. Then, April.
Q Quick question. David Sanger has a story in The New York Times today. In it, he says that the White House is considering changes to intelligence policy, specifically holding White House reviews of foreign leaders the NSA is monitoring, a closer intelligence agreement with Germany -- Angela Merkel was someone who was being monitored -- and treating citizens of close allies as if they were U.S. persons if you were monitoring them. Is that something that you -- is the story correct? Is that something you're considering? Is that something that is a response that you guys are planning on to all of this?
MR. CARNEY: The story is correct in that it reflects the fact that there is an ongoing review initiated by the President and run by the White House, concurrent with ongoing reviews done by the bodies that we've mentioned in the past. Beyond saying that the review has as a special focus [on] matters involving intelligence collection and heads of state and allies and friends, I don't have any updates to give you on what's being considered or what has been ruled in or out.
We will have more information for you on the review when it's concluded at the end of the year. And we'll -- in keeping with what has been a unprecedented level of declassification when it comes to NSA activities, we'll endeavor to provide as much information as we can, understanding that the very things we're talking about here involve intelligence-gathering and, therefore, necessarily need to be protected.
We've spoken openly about addressing the concerns that some of these revelations have raised among our allies directly with our allies. I read out the phone call that the President had with Chancellor Merkel in which this was discussed and he offered her reassurances. And we've made clear that this has been a point of discussion between the President and other leaders, as well as obviously in government-to-government diplomatic communications. And those communications continue.
Beyond that, I don't have anything specifically to say about that article, except that it does reflect that this review is underway and that it is looking at these very matters.
Q Just quickly, on the Morsy trial, is that something that the President is following? Is that something that the President or other senior administration officials are taking up with Egypt? Or is that a matter that you're going to have hands off, let them handle it, and we're not going to --
MR. CARNEY: Well, the President is obviously closely following events in Egypt. And Secretary Kerry was recently in Cairo to reiterate U.S. support for the Egyptian people in their transition to democracy and to discuss the way forward with the interim government.
Now, the interim government that replaced Morsy had the support of millions of Egyptians, as we all know, who believed the revolution had taken a wrong turn. But the interim government also has made decisions inconsistent with inclusive democracy, and we've pointed those out.
So this is an ongoing priority in the foreign policy realm for the President, for the Secretary, for the National Security Advisor and others. We have made clear when it comes to our view on the need -- we've made clear that the United States believes that there has to be an end to politicized arrests and detentions, and we'll continue to make that call. And we continue to look to the government of Egypt to ensure that Egyptians are afforded due process with fair and transparent trials, and that civilians are tried in civilian court.
So Egypt is something that remains a high-priority issue for all the national security principals.
Q Jay, going back to what Peter asked, when you ask the President about his bullying issue, can you find out does he separate bullying for children versus adult bullying? Or is it all the same?
MR. CARNEY: Well, I'm not sure I said I was going to go talk to him about the Miami Dolphins report. But the President spoke --
Q I was hoping you’d take --
MR. CARNEY: That was very clever. (Laughter.) But the President will -- I would certainly point you to what the President has said and others have said about bullying in the past. I don't have any insight to provide to you about his views on this report and I'm not sure that I'll have that for you, but if I do I'll let you know.
Q And what’s the White House thoughts today on the elections? Is Obamacare, Affordable Care Act, is that up for discussion for people at the polls, possibly? What about also the back-and-forth between both sides of Pennsylvania Avenue, particularly Republicans and Democrats? And also, is the shutdown up for discussion for a lot of these voters? What do you think is in play today?
MR. CARNEY: Well, I prefer to wait for the results before we analyze them. I think a couple of things about sort of the general discussion, which is that the shutdown -- we learned again today, with another report on consumer confidence that dropped dramatically in October, in fact, the lowest in that report since 2008 -- that the shutdown was basically a willful, deliberate action taken by some in Congress to do harm to the economy and do harm to the middle class -- a wholly unnecessary decision to, for ideological reasons, principally -- at least initially, out of ideological opposition to a law that provides affordable health insurance to millions of Americans -- to shut down the government and threaten default. And we are now, and we will for a long time experience the consequences of that kind of reckless behavior on Capitol Hill.
Data that we keep getting reflects that -- the unemployment claims, the confidence figures. I think we can expect that data going forward will reflect the hit that our economy took because some lawmakers decided it was more important to wage an ideological battle -- once again, over health care reform -- than to fulfill their basic responsibilities to the American people when it comes to not inflicting wounds on the economy gratuitously. Because that’s what they did.
And we've moved on here, in this room and elsewhere across Washington, on what the story of the day is, and I'm not arguing with the fact that there are other stories to cover, because there are. But when it comes to the American people out there, I guarantee you that most of your readers and viewers and listeners care a lot more about their economic plight and how that shutdown affected their lives, and how what Washington does affects economic growth and job creation than a lot of other things -- anything else, really. I think every organization here that does public opinion research will tell you that that is the overwhelming preoccupation of the American people.
And so when it comes to the issue that Americans care about the most, we saw a gratuitous insult to the American people by the decision to shut down the government and flirt with default, and we're going to pay a price as an economy for a while now because of that decision.
Q Jay, just a quick one -- thank you. Do you think you can get us a list of the insurers that Mr. McDonough met with today? And then the other one is --
MR. CARNEY: I'll see if we have more information on that.
Q And are you asking, or does the White House want the insurers to kind of delay these cancellation notices until you can ramp up the information necessary so people can make --
MR. CARNEY: I think the readout I gave you I think was pretty substantial and I don’t have anything more on it for you. I think -- we're in November. I think what our message is broadly is that we all need to make sure that those folks -- that portion of the 5 percent who are affected by this because their coverage was changed or canceled in the previous three years are being made aware of the options available to them.
When it comes to substandard plans, they need to know that there are better options available to them -- that they might qualify for Medicaid, because it's been expanded; that they might qualify for a tax credit, which will bring down the cost, the premium cost for the better coverage that they'll receive. So I think we're working together with everyone involved in the marketplaces to make sure that information is getting out.
Q Jay, were the President's remarks yesterday at the OFA event an effort by him to fix the 'if you like it, you can keep it' statements that he had made previously, by elaborating on them?
MR. CARNEY: No, Mark. I think what the President said last night is consistent with what he said in Boston when it comes to this issue, when it comes to those who have been getting notices, that fraction of the 5 percent that have been getting notices.
What we're trying to do here is make sure that Americans have all the information they need. And we accept that because of the problems with the website and other issues that it's on us to make sure that they're getting that information. And we need to do everything we can to improve the means by which those people can get the information they deserve and that they get, then, the benefits that they have and deserve under the law.
Q Is President Obama aware that there are people who feel misled or deceived or even lied to by his previous statements?
MR. CARNEY: Look, what I would say is the President has worked with Congress to pass a law that addresses the concerns that millions of Americans have about the insecurity created by a total lack of insurance or a lack of quality insurance. And his commitment to everyone out there who’s affected by this is to make sure that they have better options available to them, that they know that they can get subsidies, that they may qualify for Medicaid.
The purpose here is to fulfill the promise of the law. And everything that has happened because of the website that has made that harder is something that frustrates him enormously. But he’s focused on the American people for whom the benefits were designed.
And I understand -- and I think this goes to what I was saying before -- that there’s a lot of focus here in Washington on the problems that have been associated with the rollout of the Affordable Care Act or the marketplaces. And that's absolutely fine and appropriate. Most Americans out there are focused on their bottom lines. They're focused on what the local economy and the state economy is doing and what it means for them. They're focused on whether or not Washington is taking action to grow jobs and create more middle-class security.
And to the extent they're focused on health care because maybe they're not one of the 80 percent that is covered by their employer or Medicare or Medicaid or the VA is on getting the kind of security that the Affordable Care Act offers in the provision of quality, affordable health insurance.
That's our focus. This goes to economic security, principally, as well as broader goals that include reducing the deficit and getting a grip on what were exploding health care costs that hurt our employers and hurt the government and hurt the taxpayers around the country.
Q And aren't some of them focused on what they thought the President told them but turned out not to be the case?
MR. CARNEY: Mark, we are focused on making sure that the people who got these letters that you're talking about understand two things: one, that they have options available to them that will absolutely mean better insurance coverage than what they've had in the past; that they may get it without any cost if they qualify for expanded Medicaid, and they may get it at reduced or the same cost because they qualify for tax credits.
That’s the President's focus. And that’s the focus of the entire effort within the administration on implementing the Affordable Care Act and making sure that these marketplaces are working effectively.
I owe one in the back there.
Q Tomorrow marks a year since the President's reelect, and I wondered if you could share some insight on how the President feels about that, and what he feels like he's accomplished in the last year.
MR. CARNEY: Well, look, if you're asking me how he felt about the reelect, I think he's pretty satisfied with the result. But what I think is true of this President is true of any President who is fortunate enough to have been elected to this remarkable office for two consecutive terms, which is that it is your absolute responsibility to wake up every day focused on working for the American people; for figuring out what you can to make the economy better, to create more jobs and increase middle-class security, and to make sure you're making decisions that enhance the security of the American people when it comes to the threats against our nation that are still out there.
So these are all weighty responsibilities that come with the office. And eight years can seem like a long time, but given the challenges that face us and all that we have to do, the President is focused on using every day that’s available to him, that he was given through the election process by the American people. And every time we meet with him, he's focused on what can we do today to achieve some of these long-term goals. Because he may be focused on what we can do today, but through all the back-and-forth that we've seen this year over so many issues, he is always focused on the long term here, the long-term objective, even if there's a lot of upheaval and difficulty in the short and medium term.
And I think that’s a function of the fact that he came to this office along a path that was different from most of his predecessors, that he hadn't spent a lot of time in Washington engaged in the who-wins-the-day-or-the-week activity that can sometimes become the focus here. He came here because he believed that with the help of Congress and with the help of a lot of really dedicated people, we could bring about some positive change -- he could bring about some positive change with that team for the economy and for the people.
Q But can you point to any tangible accomplishments in the last year?
MR. CARNEY: Amie, yes, I certainly can. I would say that a goal that probably most people in this room and certainly everybody in Washington said would never happen, which is that we would make permanent tax cuts for the middle class and raise rates on millionaires and billionaires happened on the first of this year.
I would say that the enormous progress we've made on immigration reform, which the President made clear was a top priority for 2013, is a result of the efforts of the President and everyone else here in Washington, Democrat and Republican, and all the stakeholders around the country who have worked tirelessly to bring about this essential change for our economy. We're not there yet, but we have an enormous amount of progress that we can point to.
And the fact that it is now -- I mean, the President had a meeting today -- today, Josh, was immigration -- yes. So this is -- what the President has pointed to about -- we have a coalition here on pushing for immigration reform that is unlike any coalition that we usually see, which is business and labor, law enforcement and faith leaders, Democrats and Republicans. And the benefits of it would be enormous for our economy, for innovation.
There’s the not insignificant fact, even though the situation in Syria remains horrific for so many reasons, that I can stand here today and say that the Syrian regime is destroying chemical weapons and the apparatus to make chemical weapons that it did not even acknowledge existed a month ago. That's a big deal.
But we've got a lot of work to do, and the President knows that. And that's why he wakes up every morning focused on that work.
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