Transcript of Press Conference on Patients' Rights Ahead of Affordable Care Act Anniversary

Washington, D.C. - Democratic Leader Nancy Pelosi, along with Congresswomen Diana DeGette and Debbie Wasserman Schultz, held a press conference today, ahead of the one-year anniversary of the Affordable Care Act later this month, to highlight the benefits and rights millions of Americans are already seeing with the enactment of the law. Below is a transcript of the press conference.

Leader Pelosi.  Good afternoon.  I am very pleased to be with all of you this morning to stop diabetes, among other challenges that we have, to be here with Congresswoman Diana DeGette, the chair of the Diabetes Caucus--her daughter has Type 1 diabetes, which she will tell us about, her daughter Francesca--with John Griffin, the Chairman of the Board of the American Diabetes Association, with Congresswoman Debbie Wasserman Schultz, herself a breast cancer survivor and fighter for these health issues, Mary Andrus, Assistant Vice President of Easter Seals, and again others, Sue Nelson, Vice President of the Federal Advocacy of the American Heart Association, and Christine Brunswick, the Vice President of NBCC, Director of the D.C. chapter of the National Breast Cancer Coalition that is.

Nearly one year ago, Congress very proudly made history and made progress for the American people by passing the Affordable Health Care Act.  For Americans living or born with a disability-- whether diabetes or cancer, a heart condition or autism, you name it--we ensured that your doctor will be there when you get sick.  You will be covered, and no insurance company bureaucrat can take away from you or limit your medical choice.  It was a landmark legislation which we are very proud of.

We enacted a Patients' Bill of Rights and millions of Americans are seeing the benefits.  Today because of this law, no longer can insurance companies deny coverage to children with a pre-existing condition, like juvenile diabetes or leukemia or asthma.  Soon insurers will not be able to discriminate against the 129 million Americans of all ages living with pre-existing conditions.  It is quite remarkable.  In our Patients' Bill of Rights in this bill we eliminated lifetime caps on health plans and have ended days when insurance companies could drop someone because they were sick.  That is not what insurance is.  Insurance is in case you get sick.  And for anyone with a relative or friend diagnosed with any illness or disease, limits or low cost coverage are the last things they deserve.  This affects the family.

Already young people are able to stay on their parents' insurance policy; that is, if the parents and the children agree to that.  And that is very, very popular.  They can stay on until they are 26 years old.

Seniors are getting help with prescription drug bills, and small businesses are benefiting from tax credits to help cover their employees.  The organizations here today stood up for these reforms from the beginning, representing again the millions of Americans who will benefit from reform and who need coverage most.

I was very pleased at the beginning of this year when an attempt was made to repeal health care reform and a vote was taken, that our Members, the House Democrats who supported this bill, went to the Rules Committee for 11 hours and told stories about their constituents and their families and their personal stories of how health care reform affected them.  Some of our Members waited six hours in line to be heard at the Rules Committee.

They took many of these stories to the floor of the House a couple of weeks later and some of the people themselves, the stories they told showed up at a hearing that we had.

One woman, Stacie, told us the story of her children Hannah and Madeleine.  When they were 4 years old--these are twins--when they were 4 years old they were both diagnosed with leukemia.  Both of them.  Their father was employed.  They had health insurance and for a while, they were okay economically.  But the costs got so great that they had to declare bankruptcy.  They had, of course, exhausted much of their lifetime limits by the time they were still little girls.  When they came to testify at our hearing, Stacie, the mom, told us that the children are okay now.  They are 12 years old.  They just turned 12, the twins.  They still have a pre-existing medical condition and without this bill, they would not be able to receive--they would be discriminated against in terms of receiving coverage.  But that is not the case because of the passage of this bill.  And no longer will they be subjected to lifetime limits as well on the benefits they receive.

I recently received a letter from one of my constituents, a little girl who is 5 years old.  I received the letter from her family.  The family sent the letter and they said that she has a heart condition and her coverage was dropped when she was in surgery.  Her coverage was dropped.  Of course they didn't stop the surgery.  But they did stop the coverage.  That is just not right.  That is just not right.  And so this Patients' Bill of Rights makes it right for the American people.  And we are very proud of it.

Again, no one can take the coverage away from Stacie Ritter's twin daughters.  And with reform, Stacie says, my children now have protections from insurance discrimination based on a pre-existing cancer condition.  They will never have to fear the rescission of their health insurance if they get sick.

Making a difference in America's families.  Today Americans--our top priority, of course, is creating jobs.  This legislation is about creating jobs, strengthening the middle class, reducing the deficit.  Four million jobs will be created by the legislation when it is fully in effect.  $1.3 trillion will be saved in the life of this legislation.  And it strengthens the middle class because as we create jobs, we want people to be able to reach their fulfillment, to be able to be self employed, to be a cameraman, to be a writer, if the arts are their pursuit, to start a business, a small business, if they are entrepreneurial in that respect, and not be job locked, job locked because they cannot take their health insurance with them.  Of course under this legislation, they will be able to do so.

So that is why health insurance reform is so important.  You didn't hear much about it at the time, but we are very proud of the fact that this health insurance reform is entrepreneurial in terms of its thinking and what it allows people to do with reaching their fulfillment in the economy.  It is innovative in terms of the prevention and the wellness that it enables people to have.  It is about the health of America, the good health, not just the health care of our country.

It is so exciting, whether we are talking about health IT and using the benefits of science to make our country healthier or our economy more innovative.  This is very, very positive.  That is why we think the one-year anniversary of this health care reform bill is indeed cause for celebration.  As we mark this first anniversary of the law, we will stay focused on creating jobs, growing the economy, strengthening the middle class, and ensuring that all Americans have access to affordable quality health care.  It is about lowering cost.  It is about expanding access.  It is about improving care.  It is a good thing for America.

And so now I am very pleased to turn the podium over to one of our special guests who is here, to Diana DeGette.  I told a little bit of her story.  She will continue.  Diana was a champion in passing this legislation, as was Congresswoman Debbie Wasserman Schultz.  Let's hear from them.

Congresswoman Diana DeGette.  Thank you so much.  Thank you so much, Leader Pelosi.  And I really want to thank all of my buddies who are here.  You can tell who they are.  They are all wearing the red shirts.  And in particular, I want to thank Steve Beringer, who is here.  He is my constituent, and I have worked very, very hard with him for many years on many different issues.  But the people I really want to thank the most are the young people who are here who have Type 1 diabetes.  I see you guys in the audience.  You are the best lobbyists that we have on these issues.  And all of the Members up here will agree that you guys are the best lobbyists.  So thank you for coming here to Washington.

So you heard the Leader say it, the one-year anniversary of the Affordable Health Care Act is coming up, and there are so many provisions in this bill that are beginning to help American families right now.  But one of the reasons why this bill was so important to me and why I used my position to make sure that we could pass it and that some of the provisions would start to take effect right away is because I know how important it is for America's families that insurance companies cannot discriminate against patients on the basis of a pre-existing condition.  And when you hear stories like the story Leader Pelosi told about a young child being in surgery and right then the insurance is denied, it is almost unbelievable to most people.  But if, like me, and all of you, you have a child with a serious medical condition and a pre-existing condition, you know that these kinds of decisions up until now have happened on a regular basis.  And I will just tell you my personal situation.

My daughter Francesca was diagnosed with Type 1 diabetes when she was 4 years old.  I am sure this has happened with some of you who are here today, too.  We had no knowledge of any family history of diabetes.  Suddenly she had all the symptoms.  We were at the emergency room and this road began for us.  And aside from all the worries as a parent that you have in the middle of the night--is your kid okay?--the long term worries that you have for your kid, up until now, American families with diabetic children have had to worry: "Will I have the insurance coverage that I need to make sure that my child has the health care that they need?  And if I do have that, will I get somehow thrown off of the insurance if I change jobs, if I lose my job?"  And I think about that.  You know, I get retired every two years, so I think about, you know, if my constituents--if Steve didn't rehire me, what would happen to Francesca?  Forget about me.  But what would happen to Francesca if I changed my job?  You know that is what we worry about.

The other thing we worry about is what will happen with the lifetime caps because it is an expensive and a chronic disease to treat.  So because of the efforts of Leader Pelosi and all of us and the White House, we passed this legislation that says right now, you can't discriminate against our kids because they have a pre-existing condition.

So fast forward.  Francesca is now 17 years old.  She has had this disease for 13 years now.  And she is getting ready to go to college pretty soon.  So now I start to think about the part about how now I can keep her on my insurance until she is 26 years old.  That is the other thing the Leader talked about.  So not only can she not be thrown off of the insurance but I can keep her on that insurance so she can pursue her dreams of becoming a musician without worrying that she won't be able to have insurance.  These are the very real issues that millions of Americans face, and this is why we are committed every day to making sure that this law stays in effect and that our children are protected.

So I want to thank all of you for being advocates, and I would ask all of the people from the ADA and the other organizations here, when you talk to your Members of Congress, let them know how important these provisions are for our families.

And so with that, I want to introduce somebody who has been a great advocate on behalf of people, not just with Type 1 diabetes but also type two diabetes and gestational diabetes, somebody who has worked hard in advocacy and who is going to talk about this from a global perspective, the chair of the American Diabetes Association, John Griffin.

John Griffin.  Thank you, Congresswoman DeGette.  How special it is to be representing 26 million Americans, children and adults with diabetes, and another 80 million people in the zone of danger of diabetes unless we prevent it, and also the several hundred of you who are on the Hill this week advocating for full funding for the CDC and NIH to discover a cure for insulin to treat people with diabetes better.

As someone with diabetes, I know how important the Affordable Care Act is in the lives of people with diabetes and their families.  We know what used to happen.  We used to have pre-existing condition exclusions.  Our children were dropped like hot potatoes when they were diagnosed with diabetes, and we know how important that is.  We also know that our friends, that if we don't intervene and prevent diabetes, we see amputations, we see eye surgeries, and we see kidney dialysis of people around this country.  And that is something we cannot afford, but yet it is needless and preventable by preventing diabetes.  And the Affordable Care Act actually has mechanisms in place to prevent diabetes and the needless waste of taxpayers' dollars on surgeries, amputations and kidney dialysis.

We share the celebration the one-year anniversary of the Affordable Care Act because it tears down walls, walls that left people with diabetes on the outside without the health care to prevent those amputations, surgeries, and kidney dialysis.  And let's call a spade a spade.  A pre-existing condition is an affliction that is bipartisan and it afflicted millions of Americans in this country.  It does not any longer.  It was a dark black hole that has been now filled with light for all Americans and for all Americans with chronic diseases.

We became involved in this fight because of people like Jessie McDonan.  Since being diagnosed with diabetes in 2004, she worked hard to control diabetes.  As someone with a family history of diabetes, she knew about complications and the serious consequences of not managing them.  But her husband lost his job.  They ended up without any insurance because of a pre-existing condition.  She looked for affordable insurance but the rates were astronomical to cover someone with diabetes.  She was repeatedly turned down.  I tried to go to clinics, she said, but our income was $100 over the maximum allowed.  So faced with those unbearable financial costs she has been forced to cut back on her insulin.

Now you know that the two of you, the two young men here who are teenagers were diagnosed when they were eight.  They know what will happen to them when they cut back on their insulin.  This bill makes it absolutely clear people will no longer have to cut back on their insulin just to survive.  And let's be honest, we talk about complications.  Complications is not a fair word for what blindness, dialysis and amputations are.  They are tragedies and they are tragedies this legislation helps prevent.

The American Diabetes Association also became involved with people like Delante Lewis.  When he was diagnosed with Type 1 diabetes, his doctor didn't hide the seriousness and said, if you don't exercise and take your insulin, you will die--quite a message for a teenage child, but serious business.  Eight years later, those words echoed in his head as he struggled to pay for those medications.  During the recession, he lost his job as an assistant store manager.  Without insurance, his health care costs tripled, causing unspeakable financial difficulty on his family.

Before health reform, we had a system that would pay for amputations but not the tools to prevent those expensive amputations.  If you had diabetes like me, then you were just one job loss away from losing all of your insurance.  Or if you have small children you have the misfortune of being diagnosed with a chronic disease, they too would be dropped.  That is because that was the rules of the game then.  We were on the outside looking in, as opposed to now.  So we celebrate the one-year anniversary of the Affordable Care Act because we know when this law is fully implemented, it is going to tear down those fences for people with diabetes, cancer and heart disease.

The fence is already down for Sue Jean Hartman's son Ryan.  Ryan was diagnosed with Type 1 diabetes 2 years ago when he was a teenager.  Luckily he had coverage from his father's job.  But in less than a year, he aged out and got too old to be on his parents' coverage.  Yet work is ahead of us because he was in a black hole.  He could not do anything.  But in August of last year when this bill became law, his coverage was reinstituted and his family is now protected in ways that they never were before.

There is still much work ahead of us in this job.  Defending these gains and implementing them is going to be challenging.  Yet we know that the millions of Americans with diabetes are 100 percent committed to making sure these walls remain rubble.  Pre-existing conditions, a relic of an ugly past and diabetes cases prevented.

So at this one-year anniversary the real news that this legislation helps American families and taxpayers, no more pre existing condition limitations, no more cherry picking, no more limits on people's lifetime insurance.  The needless billions of dollars that would be spent on surgeries and dialysis and amputations can be avoided and prevented with this Act if it is fully supported by the Congress.  Thus, these gains are real and we will not allow them to be rolled back.

And thank you, everyone in this room, who have improved the lives of people with chronic diseases.  Thank you.

Congresswoman Debbie Wasserman Schultz.  Thank you very much, John.  I am Debbie Wasserman Schultz.  I am a Member of Congress.  I represent the 20th district in south Florida.  The Affordable Care Act has also been incredibly beneficial in our fight to end cancer.  As most people know, I was diagnosed with breast cancer just over 3 years ago and successfully underwent a double mastectomy and an oophorectomy to remove the cancer and reduce the chance of recurrence.  In one day overnight I went from being the picture of health to being a person who was living with a pre-existing condition and will live as a person labeled with a pre-existing condition for the rest of my life in spite of the fact that I took every step I could possibly take to make sure that I never have a recurrence of cancer again.

Without the Affordable Care Act, I and any other cancer survivors would find it almost impossible to obtain health insurance.  I was fortunate.  I found the lump in my breast early.  I had health insurance.  And I could afford the surgeries needed to ensure my recovery.  But far too many women in America are not as fortunate.  I had so many women come up to me and confess that they haven't had a mammogram in years because they can't afford the expensive copayments or they fear the prohibitive costs of treatment.

Even more troubling are the women who have come up to me in airports and grocery stores and said in almost a whisper, I found a lump in my breast but I can't go to the doctor because I am between jobs right now and I don't have health insurance.  I can't be diagnosed now and end up with a pre-existing condition that prohibits me from being able to obtain coverage in the future.  I mean, I can't even imagine facing that after getting hit with the anvil that I was hit with a breast cancer diagnosis.  This is crushing to me and to so many, many women and families.  When breast cancer is detected in early stage the 5 year survival rate is 98 percent now.  But it is only 27 percent for late stage disease.  We know that cost barriers have been adversely affecting women's ability to fight and survive breast cancer and we know as a result that women are dying.

The Affordable Care Act changed all that.  A cancer diagnosis will no longer be a sentence that a woman or a man is uninsurable.  Women will have the coverage to be able to go to the doctor for regular exams, including mammograms, beginning at age 40.

Provisions that have already taken effect include ones that are of great significance to the many seniors in my district.  The Affordable Care Act eliminates out of pocket costs for preventative services for them such as mammograms under the Medicare program.  And legislation that I sponsored, the Early Act, that passed as part of the Affordable Care Act, establishes education campaigns for the public and health care professionals regarding young women's breast health.

The Affordable Care Act will save the lives of countless American women.  We cannot allow Republicans and insurance company bureaucrats to take us backwards in the fight against cancer.  We must stand together against cancer.

Thank you so much.  And now I am pleased to introduce Mary Andrus with Easter Seals.

Mary Andrus.  Thank you, Congresswoman.  Leader Pelosi, we want to thank you for inviting Easter Seals to be here today to celebrate this one-year anniversary of the passage of the Affordable Care Act.  That legislation which is now the law of the land signaled a new commitment to making health care available and accessible particularly for people with disabilities.  The completion of work on this measure a year ago was a profound step towards real health care reform.  Easter Seals believes that the goal of this effort was and is to assure that all people have access to quality affordable health care and long term services and supports that meet their individual needs.  It is through these fundamental changes in the health care system that we can enable all Americans, including people with disabilities and chronic conditions, to be healthy, functional, live as independently as possible, and participate in their communities.

Easter Seals strongly supported this transforming legislation and in particular specific provisions, including insurance market reforms, long term services and supports including the CLASS Act, and affordability provisions.  We see these hard fought changes as significant in the pursuit of affordable, quality health care for those who have had difficulty obtaining and retaining insurance coverage.

When the bill became a law, a new phase of work began.  Easter Seals is now involved with businesses, Governors, State legislatures, and Health and Human Services agencies all over the country to provide support and guidance as new mechanisms and policies are put into place.  Success is already apparent.  Now a parent's insurance policy can cover an adult child with a disability until they are 26.  A child cannot be refused insurance coverage because of a pre existing condition, and lifetime limits on insurance coverage are prohibited.  Access to appropriate and high quality health care is essential for people with disabilities to live, learn, work, and play in their communities.  This law is a gateway to making that possible.  And we have much to look forward to.

Leader Pelosi.  Mary Andrus of Easter Seals and John Griffin from the American Diabetes Association, thank you so much for your beautiful testimony as to why this is important because of what it means in the lives of people and families.  I am so proud of my colleagues for sharing their personal stories, Congresswoman DeGette about her child, about her daughter, and Congresswoman Debbie Wasserman Schultz for sharing her story of being a survivor herself.

So from their personal experience and your personal experience and professional dedication to making America healthy, we are grateful to all of you.  It is pretty exciting.  Hearing you say it all, it is very, very exciting.  It represents real change.  Sometimes that menaces people because they like it the way it was before when they had it their way financially, economically, and the rest.  But this is about again our Founders giving us the calling for life, liberty, and the pursuit of happiness.  We believe that this bill gives people a healthier life to pursue their happiness in whatever field that may be and in a very healthy way and a very strong family and a much stronger and healthier country.

With that, I would be pleased to take first of all any questions on the subject of the health bill.  Questions?

Q: Madam Speaker, you said that the health care law will create 4 million jobs but the CBO director, Doug Elmendorf, told the House Budget Committee that the health care law will kill 800,000 jobs that will result in the reduction of 800,000 jobs in the workforce over the next decade.  Is the CBO right or wrong? 

Leader Pelosi.  I don't know the reference that you are making.  But I do know that right now this year the biggest growth in jobs in our economy has been in health care jobs.  We are talking about, with this being a catalyst bill, the jobs in health IT and biomedical research and health care providers at every level, every step of the way.  We are very, very confident about those numbers.

One of the things, since you bring up another subject, that we are concerned about right now is that in the Continuing Resolution that is being put forth by our Republican colleagues, there is a cut in funding for the National Institutes of Health.  This is not a healthy thing for our country because that research has answers.  We know that every family in America is one telephone call, one diagnosis, one accident away from needing the kind of biomedical research that can cure, really have the biblical power to cure in a very, very special way.  So to cut back on that research is wrong.

I am very pleased that in addition to passing the health care bill last year, we also passed the SCHIP, the Children's Health Insurance Program, to accelerate the health for our children.  But we also in the Recovery Act had huge investments in biomedical research at the National Institutes of Health and huge investments in health IT so that information technology, electronic medical records and the rest again bring health care closer to home, having that information follow people wherever they are.  So we are very, very proud not only of the bill but the accompanying legislation and funding for National Institutes of Health, health IT, etc.

Q: Madam Leader, how confident are you that this law stands as is?  I am not thinking about some of the more minor tweaks on the 1099 front and some other changes that might be coming down the road.  But I am thinking the core of the law, the individual mandate, the coverage expansion, the Medicaid expansion, the employer requirements under the law, how confident are you that this…

Leader Pelosi.  I feel pretty confident about it because this is a very balanced bill despite the misrepresentations that were made about it.  It had the goal of making America healthier, of reducing costs.

Suppose all of you loved your health care and your health insurance.  Suppose that were the case, which it obviously is not, but suppose every person in America was perfectly satisfied with their health care and their health insurance.  We would still have to do this legislation because we simply were on an unsustainable course of cost, cost for individuals and their families, cost to businesses to provide health insurance for their workers, costs to the economy in terms of our competitiveness, internationally, other countries.  Businesses in other countries don't have to deal with health care costs.  But our companies do and that is a competitive issue and cost to the national budget.

So personally, economically, fiscally in terms of our budget, we could not sustain the course that we were on.  Every piece of this comprehensive bill is essential to reducing costs, improving quality, and expanding access.  And that is why when we talk about some of the Patients' Bill of Rights they are rooted in some of the provisions that you talk about.  You really can't separate them and the more people know about what this means to them, the stronger the support will be.  So I feel pretty confident about the legislation.

I would like to see if any of our guests would like a response to any questions they may have on health care.

Q: The question related to--we keep on hearing about funding being cut for the different areas that will implement what is in this bill.  What are the real impacts going to be of not funding different agencies to the degree they should be funded on?  What is going to happen with the implementation?

Leader Pelosi.  Well, thank you for your question because that is one of the attempts that are being made in the Continuing Resolution as well.  One point was that the majority voted on the first day they were here to give themselves access to the Federal Employee Health Insurance Program.  So they voted for this exact benefit for themselves, and two weeks later voted to repeal it for everyone else in America.  I guess their message is: "If you want access to health care, run for Congress."  Not everybody can do that.  And so now they are trying to take little pieces away.  I think they had like 11 initiatives in the Continuing Resolution about how they could cause harm to this legislation, which doesn't affect them, mind you.  Their health insurance is intact.

So we just have to fight the fight.  And the American people will have to know what is at stake when you talk about diminishing the funding for the implementation.  The same as we have to fight that fight in the bigger Continuing Resolution because there are also attempts, again, at National Institutes of Health and other initiatives that will be harmful beyond the implementation of the bill but diminishing the investments in biomedical research.  And not only biomedical research.  Many of the discoveries that we have are from biomedical research that is advanced because of improved instrumentation.  So more investing in physical sciences.  And beyond life sciences, we are also improving our capability to see a cell and to see a path to a cure.  It is all connected.  And you know what, it all creates jobs in our country and also makes us healthier at the same time.  So we will fight that fight.

But in the cases you refer to specific to the health care bill but also in other cases, when we are cutting K-12 education and Meals on Wheels for 6 million seniors and Head Start initiatives.  And imagine the impact on health to stop the funding for implementation of clean air, clean water, and food safety.  What an impact that has on the health of the American people as well.

So we have to talk really about the value of a healthier America, about the value of creating jobs and moving the economy forward as we have these debates.  It is really more about values than just about dollars.

John Griffin.  Madam Leader, to answer this gentleman's question, our perspective is, heart, cancer and diabetes patients will not allow these protections to be rolled back.  The American people just will not put up with that.  These people in this room, that is why they are not going to put up with that.  There are millions of people who are--the protections that are built into the Act are so important to the American taxpayers and public, they will not let it be rolled back because it is that important to people with heart disease, cancer, and diabetes.

Leader Pelosi.  Okay.  We will move on.

Q: My question is, the Vice President was here a week ago to negotiate with you and the Speaker and everybody else.  He was in Scandinavia, Europe, and is in Russia now.  Are you surprised that we haven't moved the ball further down the field in terms of trying to forge an agreement on the Continuing Resolution?  I mean, I know the Senate had to lay its bar down yesterday.  But I mean, do you wish you could have a little more finality here?  We are only a week and a half away from running out again.

Leader Pelosi.  Well, I think all Americans want to remove all doubt that we will not close down government and the impact that that has on the lives of the American people.  We had good communication with the White House on this.  The President's Chief of Staff, his head of Office of Management and Budget, the head of his Council of Economic Advisers came to see us the day before we met with the Vice President.  In that room, it was determined that the Senate would go forward with the two bills, which they did yesterday, to see whether 50 votes might or might not be possible.  And now it is back to the drawing board.  But the debate that we will see as we go forward is again the one I mentioned.  It is about values.  It is not saying, "Well, we shouldn't be feeding our seniors or sending our kids to school and the rest of that."  That is a false economy.  It is going to cost us money in the long run, just as the changes that they want to make in some of the disease specific challenges that will cost us money in the long run.

So if the idea is to reduce the deficit, the best way we can do that is to create jobs, keep the economy going in a forward direction.  And all the economists to one extent or another have said that what the Republicans are trying to do with the Continuing Resolution will take us in the wrong direction.  We will lose 700,000 jobs.  I know the Speaker said 'So Be It.'  Our economic growth will be diminished, depending on who you talk to, from a fraction of 1 percent to perhaps up to 2 percent of an impact on our GDP.

So this is a debate not just about the specifics but about what it does to job creation and what it does to growing the economy.  The creation of jobs is the first order of business.  That is what the American people want us to do.  We have to make sure that the choices we make are in furtherance of reaching that goal of job creation and growth of the economy.

Q: But if we are here right now, you know, a week and a half later without ostensibly any progress.

Leader Pelosi.  A week and a half later as of last Thursday.  And yesterday they passed the bills on the floor and we will have to go forward.  But the fact is, if we are committed to not shutting down government, there has to be a path to do so.  But that path cannot take us in a U turn from taking our country in a forward direction of job creation and economic growth.  And that is really what the debate is.  Clearly what the Republicans have on the table will diminish our job creation and our economic growth.  I don't think the American people want us to go down that path.

Thank you all.

Hunter Sego.  Hi.  My name is Hunter Sego from Madison, Indiana, and I would just like to thank everybody who helped get this health care reform passed because it really means a lot to us with all our health care reform.  Everybody with pre-existing conditions can now really be covered and have a sigh of relief and know we are going to be covered and taken care of.  It just really means a great deal to us.  So thank you.