A day of action to preserve our care. This is absolutely essential because this is again, and assault, and assault on one of the most important rights, the right to good health. Saidend Martin Luther king of all the forms of inequality, the injustice in health care is one of the most inhuman, inhuman. We know that. We know that. We will talk more about that, but we know this is a very important value to our country to be respectful of meeting the needs of the American People. In the course of the morning on the republican plan and how that is really so and we arequestion, for the Affordable Care act. We want to see them come up with something that does not diminish what our goals were in the Affordable Care act. Those goals were to expand coverage to as many people as possible in our country, to improve benefits for everyone, and to lower the cost. So it is not just about the 20 islion people, actually it 20,400,000 people, as of today, who had Health Care Insurance who would not have had it before. It is also about the 155 Million People who get their benefits through the workplace and expanded benefits that they have, whether it is no preexisting condition being a very to insurance, whether it is no lifetime or annual limits on the coverage they receive, their children being able to sit on their policy until 26 years old, whether being a woman is no longer a preexisting medical condition. [applause] our whether it is insisting Health Insurance companies spend 80 of the money they received on the health care of their policyholders, and not on advertising and ceo pay. In terms of Community Health centers, and essential part of that would be overturned with the repeal of the Affordable Care act. The list goes on and on. But a new number i want you to carry with you and use is 27 . At this conference yesterday, i heard a doctor make a presentation. Under the age of 65 not on medicare, under the on of 65 will be insurable because they have preexisting medical conditions. The cost will be so astronomical, it will not be able to happen. That is not what our country is about. Out, i say, the republicans want to make america sick again. We will not let that happen. So what can we do about it . Everybody sees the urgency. Many of you want to take responsibility as you see that urgent need. We have this opportunity to have people take another look at the Affordable Care act, to dispel what they had heard, misrepresentations they had heard before. To that end, im honored that we have two special guests to talk about this from their experience. Secretary diana dooley is the California Health and Services Secretary appointed by governor jerry brown. Brown in hisvernor first term, has been involved in the private sector, the nonprofit sector. She knows the health issue from every angle. When she speaks on the subject, everyone listens. She is an expert, and california has led the way cover california has led the way in being an example to the country. Thank you, secretary julie, for being with us. [applause] before i bring her up, i want you to know who else is with us. Ehrlich is the ceo of the zuckerman San Francisco general hospital. She hasny occasions hosted us there for us to make presentations, hear stories, and the rest. She is on the front line of providing health care in our community. She has been a tremendous leader. Her background serves us all well. We are all here, again, to make sure health care is viewed as a right for all americans, not just for the privileged few. Dr. Ehrlich has dedicated her life to that. So lets first bring up secretary dooley with our respect for Governor Brown who 1970s. D her, in the all these years later. Her experience is vast. We are delighted she is with us today. Secretary dooley. [applause] thank you so much. We are also lucky to have later loc for her entire career but never more so than now. Thank you so much. [applause] secretary dooley and i do feel very humbled to be with you today at this really important time. Through the leadership of the people of the people of california we have been at the forefront of making the Affordable Care act real for californians, and showing the rest of the country what can happen when we put aside partisan differences. California has understood for many years that we have challenges in the delivery system. While the coverage expansion has been the primary focus of the work we have done, and certainly, im very proud of the work covered california has done to add nearly a million and a half people to coverage that would not have had it, but also through our Medicaid Expansion where almost 4 Million People that could not get coverage before, are now covered across california. But this has happened because we have worked very hard for many, many years to do this. It was enacted in california with the leadership of the congress but with a republican governor. We locked arms and made it work in california with people like dr. Like in our hospitals, in our communities, with our county eligibility workers, with our community clinics. I could go on and on. The way we have changed health care in california is really nothing short of draculas. The Brookings Institute just last week did a survey of the state that had embraced to some degree the Affordable Care act and said california was leading the nation. Dont get me wrong, i dont have a Mission Accomplished sign above us. There is a lot of work to do, and we all know that there are access problems and challenges with relationships between primary care and specialty care, and hospital care and outpatient care. I think what obamacare, and the rhetoric around this, gave a name to problems and health care that did not have anything to do with the Affordable Care act. The Affordable Care act was to address those problems and solve those problems. And we have. We have done it in so many ways. In the employersponsored care, the premium cost is lower than it has been in 15 years. The trend before the aca was about 8. 5 premium increases. Since the Affordable Care act, those premium increases have held at about or. 5 over that over that same period. We have had an average of 7 increases even in the covered california exchange. Until ourer 5 oneyear blip this year. So we are changing the way health care is delivered, we are improving the efficiency and the quality, transparency. We have essential benefits across all of the products that people can understand. To, believe me, it is hard fight with understanding how to get the care we need, and there is more work to do. But we certainly cannot go backwards, as the repeal, and even the replace language and i am working right now just to keep my people running the programs that they have, because if we get distracted analyzing every tweet and every possibility that is out there, they are completely irreconcilable. If you feel confused when you read the news every day, it is for good reason. You cannot reconcile what they say about wanting to have better care and lower cost and more health. That is what the Affordable Care act is. It is sort of sad that the people who are getting it right we the comedians who say have that, it is called the Affordable Care act. In the six years i have spent making it work, believe me, this is a team sport. It has involved a lot of people across a lot of sectors in this. It also is not the most radical of democratsot wanted. Many of us were singlepayer advocates. Many of us still are. [applause] but we have a plan that is working. We cannot let the perfect be the enemy of the good. Ins plan was romney care massachusetts, shorts and anger care in california schwarzenegger care in california before it was obamacare. The irony of it being opposed by the people who designed it is beyond me. I cannot understand it. But my job is to follow the law. We have a law on the land, its working in california, and it will continue to work if people across this country on this national day of action will get through the rhetoric, to their reality. Because what israel is people are getting the care that the president has talked about wanting. It better, iake will be there every day to try to make it better. What i have seen so far will not make it better. We need the kind of action that you represent year and across this country. I was born and raised in the San Joaquin Valley of california. I know how disadvantaged communities live and work. I had no Health Insurance myself until i had a job after college. California valley of has benefited perhaps more than any other region of california. Yet, we have elected leaders in that part of the state that are not acknowledging the benefit to their people. So we need to help our friends and colleagues and neighbors across the state and across this country understand what the Affordable Care act really is, not what it has been represented to be. Leader pelosi, i cannot thank you enough. I am here to be your partner to do everything we can to make it work. [applause] Speaker Pelosi thank you, madam secretary. Remembertant thing to about the Affordable Care act, medicare, medicaid, and the Affordable Care act are wedded. India for the cure as we prolong the life of medicare, we began closing the donut hole for the cost of prescription drugs. We have the free checkup to keep seniors healthier sooner. The whole bill is about prevention and wellness. About a healthy america, not Just Health Care in america. Wellness even in advance of that here in the medicaid piece of it is very central. Thought of to is be for poor children and their families, and a large number of beneficiaries of medicaid are children, a much smaller percentage of the money is spent on children. 50 of the funds are spent in nursing homes, on seniors in nursing homes, comes from medicaid. If i said medicare, forgive me. It comes from medicaid. A lot of the long term care, whether it is in a nursing home or day care for seniors, etc. , comes from medicaid. And the governor of ohio, republican john kasich, said, thank god for medicaid. That is going to help me fight the opioid epidemic. Its about addiction, opioids, and the rest of them. [applause] so we do have some republican governors who are helping us who have expanded medicaid in their to protecting us medicaid. Because they are really out to get medicaid with a cap, block grant, and the rest. They are out to get medicare. They have a provision in their budget to remove the guarantee of medicare. Medicare is a guarantee. Remove the guarantee, you have something else. I thank the California Alliance for retired americans are going to the republican districts to make these points as well. [applause] so with that, its now my pleasure to bring up dr. Ehrlich. To say one word about her and the work that she does, it is about respect, respect for the patients she sees. It is about treating them as if they are the most privileged person in america. You know what . Her care for those people mix the privileged person in america healthier, because including everyone in the loop, we learn so much. We care so much. It teaches us a lot about how to keep people healthy. That is what they do at the zuckerberg San Francisco general. Thank you, dr. Ehrlich for being here. [applause] dr. Ehrlich thank you, leader pelosi. I appreciate your leadership on this issue. Good morning, everybody. I am susan ehrlich, the ceo of zuckerberg San Francisco general hospital. Im so privileged to work with 5500 people every day who worked for the department of public health, university of california San Francisco, to take care of the more than 100,000 patients we see every year at zuckerberg San Francisco general. Im honored to address the issue of critical concern, to everyone, especially our organization. What happens to our patients and thepublic hospital when Affordable Care act, if the Affordable Care act is repealed . We all know theres a lot of uncertainty right now. We dont know what the outcome will be, but we know there will be change. Leadera dooley and a pelosi have said, the benefits of the aca has been felt by our nation, by our state, and by our entire community here in San Francisco. Ofcalifornia, the expansion medicaid under the Affordable Care act has created a pathway for an additional 4 million californians lowest income residents to have access to Health Insurance. Formally people. 4 Million People. [applause] right here in San Francisco, an haveional 95,000 people been enrolled in medicaid since the passage of the Affordable Care act. [applause] that brings the total membership meaning,0 people, here, a quarter of san franciscans are covered just by the medical program. And we are a healthier city as a result. Fewer san franciscans are delaying needed care now that they can have a primary care doctor, like me. Primary care and simple disk is highquality providers and hospitals. More san franciscans now assess their health care as good or better. We have made such great progress, and that is why we are so concerned about this effort to repeal. So what are the effects of appeal to our patients . The urban institute and the Robert Wood JohnsonFoundation Report the number of uninsured people in the u. S. Would rise by 24 million by 2021, an increase of 81 . Millionuld be 14. 5 fewer people with medicaid coverage in that same year. So these people, newly frozen out of the copperheads of benefits they have today, would unnecessarily get sicker, they would not go to seek medical care until they are acutely ill, they would find medical attention through our Emergency Department which is already full and requires more wait time, less effective for chronic conditions, less efficient, and costlier. Why would we want to do this . No congressional proposals to replace the aca will improve our Health Care System if they threatened to have our most vulnerable citizens revert to andg without insurance, doing without routine care, in order to pay for food, housing, and other basic needs. That is an unfair and undue burden for our patients. Putal of the aca will also a strain on all hospitals, and particularly, our Public Safety net hospital throughout the hospital zero at the country and in california. That hospitals could face a net negative impact of billion dollars. The scale of this loss would harm many hospitals, and in particular, make many Public Safety net hospitals, like ours, unsustainable. The loss would mean cutting services, shortening hours, and ultimately, seeing fewer patients. Americas essential hospitals, the organization which represents safety net hospitals throughout the country, says the loss of the aca coverage could result in on company 54ompensated care costs of . 2 billion over a 10your period. These losses will be devastating to all hospitals, all public hospitals, especially those with or localources investment in care, like those in the central valley, or the southern part of the state. One thing that is really clear is that at zuckerberg San Francisco general, our mission has not changed. Our mission is to provide our patients and our Community Health care with compassion and respect, regardless of income or insurance, or immigration status , sexual orientation, religion, or national origin. [applause] and and we have our california experience here leading up to a day of action. Areaof them are in the bay , they are in the east bay. They are having a combined event and they are here. Theerday, we saw a few of members who are across the country and rural areas. What the doctor said about this is people in these rural areas is that they are unsustainable without this legislation. That also relates to the economy of the region. To track new investments in their community. Me, i amaid to , theyng jobs to virginia could not give the Medicaid Expansion because of a republican legislature. I went to bring the jobs i am you are to your area, not going to an area that has a functioning hospital. Our members from rural areas spoke to that yesterday on the phone. Nothing is more eloquent than a owne of his or her constituents. What can you do . I thank you for being here. Friends in tell your republican districts to call their congressman. Most persuasive argument of all, i want you to hear the story of what the Affordable Care act made in some of our guests. Medical and medicaid user. Please share your story with us. [applause] women get that up a little bit. Thank you so much and making this happen for everyone. Hello, excuse me. Thank you for everything you are doing and zuckerberg hospital. [applause] this is a little weird, i want to make sure you can hear me. I am 51 years old, i am h