DiscoverThe Axe Files with David AxelrodEp. 121 - Nancy-Ann DeParle

Ep. 121 - Nancy-Ann DeParle

Update: 2017-02-13
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Nancy-Ann DeParle, one of the lead authors of the Affordable Care Act, talks with David Axelrod about Republican efforts to repeal Obamacare, the consequences for people and for the health insurance market if the law is repealed without an adequate legislative replacement, and her argument for why the Affordable Care Act is working.

Following script is auto-generated by Speech to Text Technology:

the board for the acts files comes from rockin' mortgage my Quicken loans lift the burden of getting a home loan with rockin' mortgage and get a secure transparent home loan approval in minutes skip the bank of the waiting then go completely online at Quicken loans dot com slash X Files This podcast is brought you by sixty DB listen to conversations that go beyond the headlines business sports politics today's news plus all of your favorite podcasts download the free sixty DB at today the the the the and now from the University of Chicago Institute of Politics and CNN The X Files with your host David Axelrod the the there may be no bigger issue in Washington today in the future of the Affordable Care Act Obamacare and we had a forum the other day at the Institute of Politics University of Chicago in which two major players on the issue Nancy and the parlor was the architect of the Affordable Care Act for the Obama administration and Mike Leavitt the former governor of Utah who was secretary of Health and Human Services under George W Bush came together to talk about the future of health care under the Trump administration and beyond we're going to vote this week to two podcasts the first with Nancy and the Parra to second with Governor Leavitt to get two different perspectives on this big issue I met Nancy and the PA role at the White House shortly after I came to Washington with Barak Obama and she was recruited to help guide the process of the Affordable Care Act through Congress and what I learned about her was that she was extraordinarily smart and very passionate about the issue of health care without there would have been no Affordable Care Act so as the Affordable Care Act is now being debated again in Washington it was good to sit down with her the other day it is to politics the the the dancing and Apollo my old colleague and friend it's it's good to see you I knew I always say to people when they ask me why i so high on America to pursue great American stories and you're one of the great American stories I know and so I want you to talk a little bit about your upbringing in Rockwood Tennessee who choose to call it Rocky Point I know that's wrong Rockwood Tennessee great metropolis and I think you are trying to make it into Rocky Top I did go to university Tennessee and that's our one of our songs yeah like rope in a town of four thousand and nine East Tennessee really small place and move back there with my mom single mom who raised three kids on around you your dad was an immigrant my dad was an immigrant almost literally came over on one of last votes from Shanghai in nineteen forty nine and I know all this after the revolution right now this kind of in March only in the last few years dated because I really didn't know my dad my mom and dad met he came over to the study was at Stanford briefly and then couldn't afford it and somehow made his way to Knoxville Tennessee my mom was working as a nurse there she was an Army nurse in World War Two she and her two brothers both served in the military into her two brothers when the Navy and she was in the Army was working as a nurse and she met my father there and they move they're all Tennesseans yes yes they were from this town Rockwood where I grew up so my mom move with my dad to Cleveland Ohio where he was at Case Western for while doing engineering his study engineering in Shanghai and that's why I was born my little brother was born and then they move to Auburn Alabama where my younger brother was foreign and my father I think struggle to support his family was a student and my mom moved back to Rockwood for her mother was and so I was raised there by her eye and he never really knew her from her daddy well we saw him a few times they got divorced not long after that we saw him a few times but really didn't reconnect with him until I had my my second son and my my husband who is reporter for The York Times found my father so we reconnected then it was not a it's not a big happy ending I mean it was it was an awkward connection after all those years but my older son Nicky did did form a bit of relationship with him he died a few years ago did you ever talk about this with the president because he has his story is famous by now but the whole notion of being separated from your father and and and re uniting later he actually didn't I mean he didn't use ten and then re united by piecing together for his father's life after his father died Friday night I wish I had done more husband interviewed my father to get a little more of his history side I didn't know much about him at all and knows what your husband Jason to parlay a great New York Times reporter and author of a major figure in in journalism and a major figure in my life yes that goes without say yeah so he interviewed him in well yes he interviewed him to get more of the background on him because I really didn't know that much having grown up with me not having seen him in all those years but your mom sounds like a heroic figure in the story my mom was incredible my mom never spent a day away from us she raised three kids on our own home my grandmother was also big figure in my life and my mom was a state government employee worked as a as a clerk typist for the state of Tennessee Department of Conservation and obviously you became prominent because of your work in the area of health care and in many different iterations ultimately as the ah really want to be the architects of the Affordable Care Act but I never really discussed this with you you have in her early and very searing experience with health care than no ban until after getting ready for this conversation because of your mom's illness how much it for book talk a little bit about that and tell me whether that is something that help motivate you to go into this area well it definitely is yes so my mom as I said worked very hard and raise three children and when I was a junior in high school she was diagnosed with lung cancer and actually had some other types of cancers well that definitely can't and she been a smoker so I spent my last couple years of high school and helping her get back and forth from treatments and what I remember about it David among other things was she was so frightened and worried about losing health insurance she had health insurance through her state job and also um they told me that she would make it to my high school graduation but she did she was there and then when I came home I went to University Tennessee in Knoxville our soul wave big state university when I came home for Christmas break that year she died knew her yes I was there when she died so you know that was that was it but one of the saddest things to me was that she didn't die directly from lung cancer she probably would have this was in nineteen seventy four she probably would have but what she died of was pneumonia which she got because she was trying to go to work because she didn't want to lose too much work and her insurance you are that's the C's dad was gone and your mom died when you were just turned eighteen yeah was that the sort of hard line of demarcation in your life between being active in being adult yes I can remember getting back to school and sitting on my bed in the dorm and thinking OK this is it a new mission class over the mom probably was awfully proud because you are like you are superstar student and what motivated you that way had you you are what valedictorian salutary in something like that in your class well gosh I just I loved reading I love learning and yes my mom my mom somehow never always made me think I could achieve anything and had lots of help and you did achieve something that nobody else achieve before you at the University of Tennessee you became the student body president how how the first woman the first one yes yeah should've should've should've put in context of how big a deal was set back to how much attention to draw you a fair amount of attention I I you know I've had a lot of support in doing that it wasn't me putting myself out there I eye of round success for vice president they've been lot of women by spring why did you what we're interested in I just always loved politics and I remember in high school I got involved in political campaign Tom Weisman ran for governor as a Democrat and I was I worked after school at the little that live drugstore in Rockwood as a soda jerk and he came to town I met him I came home and said Mom I'm going to be a Wiseman gala at the rally on Saturday and she's like No no no you're not because back in those days David you know a career civil servant which is what my mom was could still be worried about losing her job if you got politically involved with the other party say she was worried that I would somehow get in trouble but I've always been interested in politics and problem solving and am so when I got to use it to the scene it was a huge thirty five thousand undergraduate student body you notice immediately became involved in in student government and we used to go and lobby the state Legislature for funding for the university and you know that's just what I enjoyed and you you've got a Rhodes Scholarship a new one ultimately one to Harvard Law School was it your notion that you will get back into government and politics at some point thought I might I mean you mentioned a Rhodes scholarship but one of the others I'm proud of is a is a Pell Grant and you know I was really helped alot by the people this country through two Cal grants to my mother's veterans benefits to the jobs I had in college I was able to to succeed in to get an education I did go back to Tennessee I did think about maybe one day I would run for something you know you you mention that it's such a interesting thing because these programs have helped a lot of people and a lot of people in towns like Rockwood where um you know Donald Trump did very very well in this election there's a lot of hostility toward government is kind of paradoxical because it's like the guy who who famously held up the sand in the Affordable Care Act debate saying Keep the government's hands off of my Medicare without a trace of irony of them there is this feeling you know that it should be that somehow you shouldn't have to depend on the government I remember feeling ashamed a little bit in college to go over to the line to pick up my Pell grant assistance you know I I remember feeling ashamed working in the cafeteria it turned out to be a great great place to hone my political skills yeah and a great investment for the country I hope so yeah for the for those but you saying that a great investment and political skills to work in the cafeteria right I felt honored to be standing net but I met a lot of people that way yeah yeah okay future politicians take note this one path to leadership so um you came back to Tennessee and you at the age of thirty one you you took over the state Department of Human Services had that come about because that's the awfully young to be thrust into that position is actually thirty ok so in fact they timed the ride anything but any time the announcements I would be thirty because the governor said just didn't think it looked right to be twenty nine in taking over the largest departments to cover all that let you know that came there's a fairly direct line from that for my college experience so as I mentioned in student government we lobbied the state legislature to get more funding for the university and the governor then the reporter chose Maine and the Porter was speaker of the house and we would go over to lobby him and that I got to know him so when he was running for governor the story is I wasn't there but the story is that Bob Squires who was a media consultant has often met with him and said Governor I've got good news bad news the good news is a lot of people know who you are you've been speaker for eighteen years the bad news is that you don't do very well among yuppies term maybe people with the state still remember it and he said water yuppies in supposedly Squire explain to his why no one of those yuppies so that point I would have just started my legal career was I was working as a lawyer handling the litigation matter in Omaha Nebraska spending most my time up there and he called me up and ask I would help with this campaign so I didn't and that's what led to the decor or was it like your classic kind of Southern politician big perilous God what you learn from him well big and big hearted so what I learned from him was you know he was a man who'd been very successful financially but who never forgot where he came from and who really listen to the people Tennessee and that's what led to his very early reform of the healthcare system people talk about the Massachusetts reform has been what led to the form for the Care Act but there's a very real sense in what in that in that what Tennessee did back in the early nineties also led there because what he did was he reformed Medicaid to use the dollars more efficiently and cover more people and add people to the roles that way now you were you I know you're there in the late eighties when did you leave your position there I left my position in eighty nine and went back to practicing law briefly and then moved to Washington so the deer was health care under portfolio at DHS they're not directly I had child welfare and rehabilitation services foster care or child abuse but also had the what used to call the FTC or welfare program and that is categorically that point was categorically linked to medicate so when the governor put together a engine health care task force to go around the state figuring out what to do I was part of that so that's where I first got involved in healthcare costs to go to Washington you know I'd been in Washington before so Aiden and in turn and then a staff assistant former President Jimmy Carter and I just always want to live there and I got to that point was a partner in my law firm and I thought you know If Not Now When I ever going to live in Washington and so I moved up there never and it was after the yum the first Gulf War and President George H W Bush was very popular in to me Washington The government town company town in the companies the government so I had to come to grips with the fact that I wouldn't be working for the company would be working in a private law firm and I moved up their preference would have been the go right into government it wouldn't that yes I always thought I would do that would have been on ever forget the night that I moved to Washington Governor reporter asked me to come have dinner with him so were sitting at the Governor's residence and he gets a telephone call and his assistant brings the phone out and it's um Governor Clinton and I only hear the quarter side of the says Billy Bob what are you up to me if supply and then it's over because Billy Bob says he's going to run for president since September of ninety one which ended up being what happened and you end up working for Billy but I did with to have that come about well again I think from that quarter I think Ki Jai well first of all it wasn't just President Clinton was also Vice President Gore re sells one of these get a good Tennessee situations where I knew both the president and vice president and they asked me to come help them and I did as first as as the health care person within the Office of Management and Budget and what did you learn in the chow well that job was one that President Clinton created to work on health care reform he famously as you know the health reform yeah and I wanted to be at OMB because I'd seen from my experience in Tennessee running the department Human Services it's important to be close to where the money is and should have all the great programs and ideas for programs in the world but needed to have access to getting the financing in getting getting it done where you there during the period when they were working on health yes plan what it failed well that would be longer than a podcast show but what are the fundamental principles that you derive from that because you would come back a decade later with Barack Obama decade later more than a decade later with Barack Obama and try and achieve the same goal so what did you learn from that experience one thing was I not to try to draft around bill then you need to work with Congress and help them get a bill done as opposed to drafting a bill it took was one of the criticisms of the Clinton plan was that it was drawn behind closed doors no congressional involvement led to resentment on the Hill about it there was congressional involvement and there was a lot of stakeholder involvement that because the wait was set up on it was a very convoluted process and writing a bill took it was you know September by the time they had a draft of the building and sat there and by then sort of you know was a circular firing squad by then everyone was arrayed all the interest groups or raid and we spent a few weeks if not months with various disease groups advocacy groups over the period to city of different tests that they wanted to have covered in the bill and what they know exactly what the benefit should look like in a lot of the people on the congressional staff who we worked with President Obama s health care reform effort were also there for that and we all basically said to each other we're not doing that again we're not going to get into those inner ness and battles that end up hurting this effort just took too long you know we're fighting the clock the whole time pretty sure pray will be back with Nancy and Apollo rocket mortgage by Quicken loans proudly supports the X Files when it comes to the big decision of choosing a mortgage lender it's important to work with someone you can trust leisure best interests in mind with rockin' mortgage you'll get a transparent online process that gives you the confidence you need to make an informed decision skip the bank skip the waiting and go completely online at Quicken loans dot com slash X Files equal Housing lender license in all fifty states and MLS consumer access dot org Number thirty thirty when you talk about the Clinton health care fight of the early one interesting elements of that was the Republicans did come up with an alternative plan and that alternative plan was very much built around a health care exchanges and some of the principles that were incorporated into the Obama plan or what would become known as Obamacare years later and some of the people who helped draft that Republican plan was still in the Senate when you arrive there the less eager to embrace their own idea yes and I have to say a lot of what happened during two thousand ninety s and ten in the president's effort to enact health reform was inspiring and uplifting but there were never things that were were not and maybe Santa Claus that's one of the examples is that people who in the Byway was just one Republican plan factoring the clan administration there had been a dozen senators who had their own plans many of which were shared many common elements with what we we tried to to work on together with them and in fact during the time between the failure of the Clinton health reform effort and when President Obama was elected there been a multi stakeholder bipartisan effort that had been engaged in for years by lots of groups and stakeholders in individuals and really the contours of these private sector plans in exchanges and tax credits and all that had an individual mandate all that have been basically agreed upon on a bipartisan basis so I won't say that I thought it would be a waltz and never thought it would be easy there's a reason why these things don't happen after seven presidents have tried is that it's embarrassing to fail right when you're dealing with a four trillion dollar industry there's a lot of zero sum games they end up getting played in it but never thought be easy but I didn't think that we would I thought there would be Republican support I really didn't your member David M I didn't start until March of two thousand and nine but in February I think the second meeting that the president had the second big meeting with Congress his first was an economic meeting the second was to bring together members of Congress as well as the years of interest groups and advocacy groups and citizens to have a health care meeting at the White House about what the problems what can we do to control costs what we do to get everyone covered and it was a half day effort we had breakout groups where they were Republican leaders and Democratic leaders together it really seemed that there was agreement that we needed to do something that we had people forget knife sometimes I feel like this debate we're having now is in a vacuum and people forget what we were facing back in two thousand and nine with forty million plus people uninsured that number projected to grow every year health care inflation yet was outta control control people forget all that everyone agreed it was a problem there wasn't anyone there was no Republican who attended he said we shouldn't do anything yeah you know um if's say I've written about this I think I've talked about it here but I was very nervous about moving forward and I was nervous about moving forward because not because it not just because I knew the history but also I knew the data on all of this and the reality was it eighty five percent of Americans had health coverage and numb even though the ultimate bill the Affordable Care Act included all kinds of reforms that affected everyone who had health care the elimination of lifetime caps for example hugely important if you get seriously ill people like your mom you of the There was this sense that this was a program for other people not for them and then the other thing was you know I remember being struck in these early meetings I would say people are really concerned about the cost of healthcare and the health care experts in there so we're concerned about costs too but their notion of what the concern was was different than my concern my concern was about the cost to individual patients and their concern was about the cost of the overall system and we never I always felt like we were talking to different languages may because I was a political hack and they were experts on the system but well but Donald Trump I must say he got that and he always talks about in terms of bringing down costs to consumers and it's it's it's an it's an alluring concept it is the rate of Cosgrove has been brought down dramatically and I remember some of those meetings are describing where we were struggling to explain how it would benefit the average person reduce the costs in fact it has and they may not know it because one of the other big struggles was communicating all this but we it seems almost quaint now but we were struggling in earnest over whether to make claims about what would be accomplished we had projections of what we thought to be accomplished for people with employer sponsored coverage we ended up not putting out a document that said this but we over achieved it so you may remember this twenty five hundred dollar number per family yes so the last eight I looked at the Council of Economic advisors data says that that so far the average family with employer sponsored coverage is saved thirty six hundred dollars And so this is third six hundred dollars of him pretty low what they would have had to spend without the Affordable Care Act but doesn't mean that their costs have gone up at all that's right the cost probably have gone up you know I remember a call I got from one of our supporters in the Senate for this who was fully supportive but said you know that once this passes you can own everything everything in the healthcare system so if anybody gets a premium increase or if anybody has a bad experience it's all going to be attributed to the Affordable Care Act it'll be your and our healthcare system now to Obamacare right to Obamacare yes and that's exactly that that did happen did happen and I think that the Republicans were the dog did in exploiting that sentiment the interesting thing is now the shoe may be on the other foot and I should give you an opportunity you know the president talks about the fact that this is a disaster we have to save Americans from this disaster we've heard this rhetoric a lot of tell me what you see the Affordable Care Act as having accomplished and where you think there are frankly places that it needs
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Ep. 121 - Nancy-Ann DeParle

The Axe Files with David Axelrod