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Meet the Press Transcript - November 16, 2014

Meet the Press Transcript - November 16, 2014

CHUCK TODD (V/O):

This Sunday, what appears to be another beheading of an American by the radical Islamic group ISIS. The victim is apparently hostage Peter Kassig, a former aid worker. We'll have a full report. Here at home, the gloves are off again.

PRESIDENT OBAMA:

What I'm not going to do is just wait.

CHUCK TODD (V/O):

On one side, a president, no longer constrained by another election. On the other side, triumphant Republicans. At stake, two huge issues: immigration and healthcare.

JOHN BOEHNER:

We're going to fight the president tooth and nail.

CHUCK TODD (V/O):

President Obama prepares to bypass Congress with executive action on immigration reform.

PRESIDENT OBAMA:

And it's way overdue. And we've been talking about it for ten years now.

CHUCK TODD (V/O):

How will Republicans respond? Also, will Republicans follow through on their goal to dismantle the Affordable Care Act? Where you stand on the issue...

ROBERT MAYFIELD:

It's going to be more taxes on all the Texas people.

CHUCK TODD (V/O):

...may depend on where you sit.

KEITH MOON:

If you don't want to repeal this law, you go without insurance for two years and tell me how you feel.

CHUCK TODD:

Plus, following the Republican midterm wave, can Democrats reassemble their winning coalition in 2016 without President Obama on the ballot? I'm Chuck Todd. And joining me to provide insight and analysis are MSNBC's Chris Matthews, Helene Cooper of The New York Times, former CEO Hewlett Packard, of Carly Fiorina, and Reid Wilson of The Washington Post. Also Louisiana Governor Bobby Jindal, a possible Republican presidential candidate. And Health and Human Services Secretary, Sylvia Burwell are here exclusively. Welcome to Sunday. It's Meet the Press.

ANNOUNCER:

From NBC News in Washington, this is Meet the Press with Chuck Todd.

CHUCK TODD:

Good morning. We begin with some grim news from Syria. Intelligence officials are investigating a video that was posted online purportedly by ISIS that claims to show that captured U.S. aid worker, Peter Kassig, has been killed. The video also shows the killing of several Syrian soldiers. Kassig, 26, from Indiana, was working as a humanitarian aid worker in Syria when he was captured by ISIS in October of 2013.

He was born Peter Kassig, but changed his name to Abdul Rahman after converting to Islam while in captivity. Now, the National Security Council has released a statement this morning. It reads in part: "We are aware of a video that claims to show the murder of U.S. citizen Peter Kassig. The intelligence community is working as quickly as possible to determine its authenticity. If confirmed, we are appalled by the brutal murder of an innocent American aid worker, and we express our deepest condolences to his family and friends."

I'm joined now by our chief foreign correspondent, Richard Engel. He is in Istanbul where he has been based to cover this war. Richard, it seems as if the government is assuming this video is authentic. What do you know?

RICHARD ENGEL:

Well, I've seen the video and unfortunately, it does appear to be authentic. We see the same, now familiar, militant dressed in all black with a distinctive London accent, saying that Peter Kassig has been killed. You don't actually see the beheading. You just see the militant and then what looks to be Peter Kassig's head at his feet.

It was a long video. It shows the beheadings of other hostages, a group that are allegedly Syrian soldiers. If, in fact, it is confirmed that Kassig was murdered, he would be the fifth Western hostage killed by ISIS. And the reason ISIS said it killed Kassig is because he was a former soldier who served in Iraq before he changed his life and went to Syria to help provide some humanitarian and medical relief to Syrian victims of war.

CHUCK TODD:

Now Richard, speaking of Iraq, General Martin Dempsey, of course, the chairman of the Joint Chiefs, he made a surprise visit to Iraq yesterday. I think he's still there. Where he's supposed to get a firsthand look at the Iraqi military. We've got advisors on the ground. There's some talk that maybe more have the go. What is the state of the Iraqi military, and how are they doing on the fight against ISIS?

RICHARD ENGEL:

I think it's very mixed, frankly. There are some units of the Iraqi military that are making some progress. They made some advances north of Baghdad in the last several days. But the military is infiltrated. It's infiltrated by Shiite militias, it's infiltrated by the Iranian Revolutionary Guard. Just a few weeks ago, in fact, a unit from the Iraqi military, backed up by militias, went into a town, they killed some ISIS.

But then they also went back and butchered Sunni civilians who were living in the town. And this was an act according to officials that I've spoken to, directly carried out by an Iranian-backed group within the Iraqi Security Services. So I think it is a very mixed record of success so far.

The Kurds are making advances. Some units of the Iraqi army are making advances. But others are Iranian-backed death squads. And this is the Iraqi army, this patchwork that we are supposed to be guiding, advising, and leading in a fight against ISIS.

CHUCK TODD:

Looks like it's going to be a longer slog than anybody wants to deal with. Richard Engel, in Istanbul for us this morning, Richard, thanks very much. Now I want to switch gears here, get to domestic politics. The new third rails of American politics these days; one, immigration reform.

Democrats now on it. Republicans not for what the president wants. And then President Obama now says he's going to go ahead with or without the GOP. The other, of course, is healthcare reform. It's President Obama's signature achievement, his legislative place in history. And here come the Republicans. They want to take it apart brick by brick.

There are two intractable issues so important to each side that neither is willing to give any quarter. Defy the other side, and you're declaring political war. And that's just what's happening. To quote Bette Davis, fasten your seatbelts. It's going to be a bumpy night.

(BEGIN TAPE)

CHUCK TODD (V/O):

If Republicans thought a wave election would humble the president, he didn't show it. Promising executive action that would stop deportations for millions of undocumented immigrants, a lightning rod for the GOP, the president doubled down.

PRESIDENT OBAMA:

And that's going to happen. That's going to happen before the end of the year.

JOHN BOEHNER:

We're going to fight the president tooth and nail if he continues down this path.

CHUCK TODD (V/O):

So much for that kumbaya lunch at the White House last week. And there's healthcare. Yesterday marked the premier of season two of Obamacare. The president now playing salesman in chief.

PRESIDENT OBAMA:

You can go online or call 1-800-318-2596 and get covered for 2015.

CHUCK TODD (V/O):

New website, new cast, and this time, administration officials hope a new story line after a disastrous debut last year.

PRESIDENT OBAMA:

Nobody's madder than me about the fact that the website isn't working as well as it should.

CHUCK TODD (V/O):

7.1 million Americans signed up and paid by the end of the first enrollment period, hitting projections. This time around, the government expects a total of between nine and ten million for 2015. But that's over three million less than the government's original projection of 13 million signups. And yes, the future of the law remains somewhat cloudy.

Thirteen states, plus D.C., run their own health insurance exchanges. Thirty-seven states, mostly with Republican governors, haven't set up their own exchange, and rely on the federal government. But what the Affordable Care Act is doing for the cost of healthcare, this map shows the change in premiums from the largest cities in each state, and it's a mixed bag. Premiums up in some states, and down in others. And in January, the new Republican majority in Congress takes office, promising to dismember the law.

MITCH MCCONNELL:

I want to pull this law out root and branch.

CHUCK TODD (V/O):

And to top it all off, the Supreme Court will hear another case this term about those exchanges, which could cripple the law.

(END TAPE)

CHUCK TODD:

I'm joined now by Sylvia Mathews Burwell, secretary of Health and Human Services, welcome to Meet the Press.

SYLVIA BURWELL:

Thank you.

CHUCK TODD:

Madam Secretary, I want to start with, we heard the President earlier this morning, or yesterday or tomorrow, however you want to talk about Australian time. He said 23,000 new applications is what he reported. Do you have any up-to-date numbers? And I guess I would ask, it seems as if new applications went well on the website. People trying to get to their old accounts struggled.

SYLVIA BURWELL:

So with regard to that, yes I do. Yesterday, we had 100,000 folks submit applications.

CHUCK TODD:

New applications?

SYLVIA BURWELL:

Submit applications.

CHUCK TODD:

Okay.

SYLVIA BURWELL:

And there were over 500,000 people who logged in effectively yesterday as well. So I think the vast majority of people coming to the site were able to get on and do what they were intending to do.

CHUCK TODD:

Do you have an issue with people getting onto their old accounts? Is that an issue that you've identified or is this just user error?

SYLVIA BURWELL:

So with regard to that, we think the vast majority were able to. That's what we see in that 500,000. In some of those examples, we're tracking them down. That's part of what I said we were going to do and what we want to do. Some people forget their user names. Some people are renewing their passwords and other things, if there were any other technical problems. Our customer service folks are ready and able to help people. There were over 100,000 calls yesterday.

CHUCK TODD:

All right. Let me ask if you if you guys have, the uninsured right has dropped by 25%. The average premium has gone down for 2015. There's Medicare solvency has increased. So a bunch of good news. And yet the public's opinion about the healthcare law hasn't changed one bit. Still more people think it's a bad idea than a good idea. Why is that? Why hasn't success translated?

SYLVIA BURWELL:

I think one of the things we need to do is translate that success because I think when you ask the American people about those things individually, or when you ask the American people about the importance of no longer being held off healthcare because of preexisting conditions, or the fact that their children up to the age 26 can be on their plans, that's three million. When you ask them about the substance of the issue, the American people respond positively. And that's what I think we need to more about.

CHUCK TODD:

So whose fault is this?

SYLVIA BURWELL:

I think what we need to do is make sure that we're communicating clearly and that we talk about what is the substance instead of something that is one-word descriptions but actually what this is. This is about three things: Affordability, quality, and access. And when you talk about, as you just did, the measures against those things, that's what we need to do more of.

CHUCK TODD:

So why is it that you had to downgrade the expectations of how many people would sign up? You're looking at less than ten million. The original projection was try to get to 13 million after year two. That's a steep expectation decline. Why?

SYLVIA BURWELL:

So the 13 million was a number that was set as CBO scored the initial bill. And scoring, as we know, is something that is done to determine--

CHUCK TODD:

They were accurate about year one.

SYLVIA BURWELL:

So with regard to that though, what we have done is when I got to HHS, I asked the team to actually look at the numbers and let's figure out what we think that target should be. It has two basic pieces to it: reenrollment and new enrollees. With regard to the reenrollment, what we did was went actually out to the marketplace, asked people, "What is the general reenrollment of this type of thing?"

They created a range that was 70% to 90%. Many of the people were in the 80% to 85%. We chose 83%. And then what we did was build the number that way. So in setting our target, what we did was take the information from last year, including the fact that when CBO did its estimates, and others did estimates, they actually thought more people would switch from employer-based care than did.

CHUCK TODD:

So you think that's one of the reasons that this, employers have to dropped people. But this is the first year the employer mandate. Do you expect to see employers drop people now?

SYLVIA BURWELL:

So with regard to the number, we think it's a number of elements. And as we made the number that we chose, that 9.1, we said there'd be 28% growth. And we believe in the second year of a new marketplace, 28% growth is strong and healthy growth.

CHUCK TODD:

All right. I've got to ask you about these comments from Jonathan Gruber. He's of course, a lot of opponents of the Affordable Care Act have been pointing to these comments all week long. He's an MIT professor. He helped write the healthcare law both in Massachusetts, an advisor to the healthcare law and to people that wrote it back when the Obama administration was working on it.

I understand you didn't necessarily work with him very closely. But I do want to have you take a listen and get you to respond. This is how Gruber explained taxing high-end Cadillac health insurance plans and sort of doing a little "okey-doke" on the American public. Take a listen.

(BEGIN TAPE)

JONATHAN GRUBER:

We just tax the insurance companies. They pass on higher prices, that offsets the tax break we get it, it ends up being the same thing. It's a very clever, you know, basic exploitation of the lack of economic understanding of the American voter. And they proposed it and it passed, because the American voter is too stupid to understand the difference.

Lack of transparency is a huge political advantage. And basically, you know, call it the stupidity of the American voter, or whatever. But basically, that was really, really critical to getting this thing to pass. So what does this bill do? This bill takes, what I call, the spaghetti approach. Which is it takes a bunch of ideas that might work and throws them against the wall, we'll see what sticks.

(END TAPE)

CHUCK TODD:

He's playing into every fear that many conservatives had about this bill, that it's not transparent, that there are things in it that people don't know. This certainly can't help a credibility gap.

SYLVIA BURWELL:

I have to start with how fundamentally I disagree with his comments about the bill and about the American people. Since I've been at the department, one of the things that I've focused on is transparency, making sure that all our numbers coming out, whether they're good or bad. And the other thing is that the law is based on the issues of transparency and belief in the American people and choices in the marketplace.

This past week, since we've had window shopping on, over a million people have come to the site and done window shopping. Because what they're doing is they're comparing. They're comparing based on premiums, they're comparing based on deductibility. When you give the American people the tools to make the right choices for themselves, they're going to do that. And that's what this is about. From the issue of actually the consumer to the fact that we have put out information so that people can see what providers are receiving from pharmaceuticals.

CHUCK TODD:

He said, "Spaghetti at the wall." And he said that the week the health care law passed. Is that what this bill is? To see what works and what doesn't?

SYLVIA BURWELL:

This law is a piece of legislation that is about three fundamental things. And these are things that have bipartisan agreement. Affordability, access, and quality. That's what the American people want. And actually, there's bipartisan agreement. The bill has a lot of different pieces. You touched on many of them, and people know about them, whether it's closing the Medicare donut hole. And there are eight million American seniors that benefited from that $11 billion. There are so many parts of this law that target those three fundamental things.

CHUCK TODD:

Is Mr. Gruber going to be welcomed back as a consultant?

SYLVIA BURWELL:

Certainly right now in terms of the work that we're doing at HHS, we are doing our work and focusing on what we are doing and our modeling.

CHUCK TODD:

So he's not welcome back?

SYLVIA BURWELL:

With regard to Mr. Gruber and his comments, I think I've been clear. That's something we fundamentally disagree with.

CHUCK TODD:

Madam Secretary, thanks for coming on Meet the Press.

SYLVIA BURWELL:

Thank you.

CHUCK TODD:

All right.

CHUCK TODD:

And now joining me since the Affordable Care Act was implemented, 23 states have not expanded Medicaid to help cover low-income individuals, leaving 3.8 million in a so-called coverage gap where their income is above Medicaid eligibility limits, but below the threshold for marketplace premium tax credit. Why does it matter? Let me show you an example in two states.

Arkansas did expand Medicaid coverage. They saw their uninsured rate decrease by 46%. Next door in Louisiana, which did not expand Medicaid coverage, the uninsured rate was only reduced by 15%. So to talk about this and some other things, I'm joined now by the governor of Louisiana, Republican Bobby Jindal. Governor, welcome back to Meet the Press.

GOV. BOBBY JINDAL:

Chuck, thank you for having me.

CHUCK TODD:

Let's go right there to that number. You look at Arkansas, your neighbor to the north. I know you don't want to talk about Arkansas right now.

(OVERTALK)

CHUCK TODD:

--that issue last night. But obviously, expanding Medicaid coverage, you'd have more people off of the uninsured roles in Louisiana if you did it. Why aren't you doing it?

GOV. BOBBY JINDAL:

Chuck, look. Democrats and Republicans both want to help the vulnerable, want to help people get affordable, high-quality healthcare. Medicaid is not the right way to do it. The problem with expanding Medicaid, the problem with the Affordable Care Act, the problem with ObamaCare, is that it chooses a top-down, closed approach, where the government is running your healthcare.

Medicaid's already a program with bad healthcare outcomes. You look at the Oregon study, they showed by expanding Medicaid, there was no improvement in physical outcomes. It was a program designed to take care of the disabled, of vulnerable children. It was never designed to be there for able-bodied adults.

By expanding and creating a new entitlement when we can't afford the ones we've already got, the Affordable Care Act, the president basically is doubling down on a failed approach for providing healthcare. There's a better way to help those uninsured.

CHUCK TODD:

Here's the thing though. It would cost your state nothing. In fact, look, you've got your own fiscal problems right now with the deficit issue. You'd have more money from the federal government. They're paying for it. It's not going to cost Louisiana taxpayers any extra state money. Why not do it while the law is enacted?

GOV. BOBBY JINDAL:

So, look, two things. Chuck, I'm glad you asked that. One of the things I love is when Democrats say, "Oh, this is free money." This is not free money. Every dollar we don't spend on Medicaid is another dollar we don't have to borrow from China. This is the reason we've gotten nearly $18 trillion in debt.

Louisiana taxpayers are federal taxpayer. These are federal tax dollars. Why waste these tax dollars? We've got to stop acting in this city like all of this money is free money. Secondly, secondly, when you look at the best way to help folks, it is to decrease the cost of healthcare. I propose a detailed plan to repeal and replace ObamaCare. If the president were really serious, why not give states more flexibility? Why not go to states and say--

CHUCK TODD:

But he has. I mean, you look at in Indiana. So why is, I guess, John Kasich wrong? Why is Mike Pence of Indiana wrong? Mike Pence did get the federal government to approve a much different plan. Why not negotiate with the government and do something that you want to do?

GOV. BOBBY JINDAL:

In Louisiana, if we were to expand Medicaid, it would cost my taxpayers $1.7 billion over ten years. For every uninsured person we'd cover, oh, we'd have to kick more than one person out of private insurance. Now, think about that. I know that this president likes to define success as more people dependent on the government. I would have to take over 200,000 out of private insurance and put them into Medicaid. To me, that's a huge mistake.

CHUCK TODD:

Yeah, but you have 200,000 not insured at all, though.

GOV. BOBBY JINDAL:

Well, but no, I'm saying for every uninsured person you're covering, you're taking more than another person out of private insurance. In Louisiana in particular, we inherited a decades-old public hospital system, unlike other states. We're the only state, we had ten state-operated hospitals. The private sector, public/private partnerships, we've actually improved healthcare access and outcomes.

For one example, it used to take ten days to get a prescription filled, now you can get it done in ten minutes. Through Bayou health, we reformed our program, we had before 5% of our adults were getting preventive care screenings, now over 80% of our-- Chuck, my point is This. There are better ways to provide healthcare to the vulnerable, to the uninsured. The answer's not for the government to be running healthcare. The answer is not to expand a failed program, a one-size-fits-all approach like Medicaid.

CHUCK TODD:

You think Medicaid's a total failure?

GOV. BOBBY JINDAL:

No, I think Medicaid--

CHUCK TODD:

But why do you implement any of it?

GOV. BOBBY JINDAL:

I think Medicaid, when it was targeted for the disabled, for children, in Louisiana, over 95% of our children have coverage. I think that it can be improved and more flexibility. Oregon, the Harvard-- now, this wasn't a conservative study. The Harvard study showed when you expanded Medicaid after two years in Oregon, there was no improvement of physical healthcare outcomes. Simply giving people a card without giving them access to healthcare, to doctors, to hospitals doesn't improve anything.

CHUCK TODD:

Very quickly on immigration. If the president goes through with his executive action, do you think Republicans and Capitol Hill ought to use even the power of shutting down the government to stop him from doing it?

GOV. BOBBY JINDAL:

Two things. I don't think the president should shut down the government to try to break the Constitution. The reality is this. I do think the--

CHUCK TODD:

You think the president would be shutting down the government?

GOV. BOBBY JINDAL:

Oh, absolutely.

CHUCK TODD:

So you do want Republicans to fight him on this to the point that it could shut down the government?

GOV. BOBBY JINDAL:

Absolute-- I don't think the president should shut down the government.

CHUCK TODD:

But you're twisting my question.

GOV. BOBBY JINDAL:

But wait, wait.

CHUCK TODD:

That means you want that kind of showdown?

GOV. BOBBY JINDAL:

Let's step back and understand what we're talking about. So the president said, "I want to break the law." He purposely said I’m going to wait till after the election, because I know it's not going to be popular to grant amnesty to millions of folks here that are here illegally. We had an election. He said his policies were on the ballot.

He lost in red states, purple states, blue states. The American people overwhelmingly rejected and rejected his policies. Now he's saying, "I'm still going to break the law." Talk about arrogance. This president used to say, "Elections have consequences." We're talking about how can the Congress force the president to follow the law?

I would expect even Democrats who may agree with him on substance, to say the right way to do this is to follow the Constitution, follow the law. No, we shouldn't shut down the government, but absolutely Republicans should do everything they can to force the president to follow the law. Let's secure the border. No, the president shouldn't shut down the government so that he can break the law.

CHUCK TODD:

All right. I'm going to ask you about your own presidential ambitions. A majority in Louisiana disapprove of your job as governor. Why is that a launching pad to Iowa and New Hampshire?

GOV. BOBBY JINDAL:

Chuck, I don't care at all about poll numbers. I never have. The reality is, I was elected in Louisiana to make generational changes. Look at what we've done in Louisiana. So now, we've cut our state budget 26%, cut the number of state employees 34%.

We've got the best private-sector economy in a generation. Our economy has grown twice as fast as the national economy. More people working than ever before at a higher income than ever before. We transformed the charity house. That's, like, the third rail in Louisiana politics.

Statewide school of choice, so our children have the opportunity to get a great education. If I were to run, and I haven't made that decision, if I were to run for president, it's because I believe in our country. The American dream is at jeopardy. This president has defined the American dream as more dependence on the government. We need to restore the American dream. So it's more about opportunity and growth and not redistribution.

CHUCK TODD:

But very quickly, one part of your record, you now have nearly a billion dollar hole in your budget. Every midyear review, your deficit has grown. You did a big tax cut at the beginning of your term as governor. Revenues haven't followed.

GOV. BOBBY JINDAL:

That's not actually true, Chuck. The billion dollars is if you assume we grow government next year. Our budget's been balanced every year. We've never raised taxes. I've had eight credit upgrades in three of the major credit rating agencies. Best credit ratings in decades in our state. We've actually balanced our budget every single year without running deficits, without raising taxes.

CHUCK TODD:

Well, you constitutionally have to balance your budget.

GOV. BOBBY JINDAL:

And we need to do that in D.C. as well. But my point is, we've actually made the tough choices. Unlike D.C., we cut our spending $9 billion. I'm not talking about cutting growth. We cut our budget by $9 billion. So we've actually balanced our budget and we've done it by growing the private sector.

We've got, right now in Louisiana, we've got more than 80,000 jobs, more than $50 billion in private investment coming into our state. We actually, our economy's doing so well, when I was elected, our worry was we were losing our sons and daughters. Today, our biggest challenge is filling all these great jobs.

CHUCK TODD:

Governor Bobby Jindal, I will have to leave it there. You're going to decide when, by the 1st of the year?

GOV. BOBBY JINDAL:

First half of next year. We are praying about this. But bottom line is let's restore the American dream for our children and grandchildren.

CHUCK TODD:

Governor, thanks for coming back to Meet the Press. Coming up, President Obama says, "Election? What election?" The Democrats' midterm losses not only haven't stopped him, they seemed to have energized him. How will Republicans respond?

***Commercial Break***

CHUCK TODD:

The controversial Keystone XL Pipeline, which would transport oil from Canada down to the Gulf of Mexico is back in the news. The senate is expected to take up a bill this week that could allow the project to go forward. So we asked two experts to argue for and against the pipeline being built in our weekly web series, Make the Case. That and more can be found on our website at MeetThePressNBC.com. Up next, President Obama and Republicans get ready for another series of partisan showdowns.

***Commercial Break***

CHUCK TODD:

And welcome back. This month's midterm results were miserable for the Democratic party. They lost the Senate, and of course, a lot more seats in the House. So with two years of his tenure left, President Obama has two options: Eke out some areas of compromise with the new Republican majority, or try to be bold and push his agenda by using his executive authority. Well, this week, it became clear that the president has opted to favor the latter approach. As they say, he may believe the best form of a defense is a good offense.

(BEGIN TAPE)

PRESIDENT OBAMA:

Without any Republican support on anything then it's going to be hard to get things done.

CHUCK TODD (V/O)

That was four years ago. This is now.

PRESIDENT OBAMA:

There are going to be actions I take that they don't like, and there are going to be bills they pass that I don't like.

CHUCK TODD (V/O)

In 2010, President Obama, realizing he himself would be facing voters in two years, walked away from the shellacking with a pledge to build consensus. The effort and accommodation failed. A grand bargain on taxes and entitlements broke down. And clashes over spending paved the way for a government shutdown. This time around, without the burden of a re-election campaign, the president is learning a different lesson from defeat. With time running out to secure a legacy, this week, the president put his fists up, telling supporters, "Let's go."

PRESIDENT OBAMA:

I'm laying out a plan to keep the internet free and open.

CHUCK TODD (V/O)

On Monday, the president pushed the FCC to issue the strongest possible rules for internet service providers like Verizon and NBC parent company, Comcast, saying the internet should be regulated like a public utility so broadband companies can't charge for better access. Republican Senator Ted Cruz called it, "ObamaCare for the internet." On Tuesday, Mr. Obama announced an historic climate deal with China, designed to cut carbon emissions from both countries.

PRESIDENT OBAMA:

For the first time, we got China to make a very serious commitment to constrain its greenhouse gasses. Why would anybody be against that?

CHUCK TODD (V/O)

Republicans were.

MITCH MCCONNELL:

I had maybe naïvely hoped the president would look at the results of the election and decide to come to this political center. But the early signs are not good.

CHUCK TODD (V/O)

As early as next week, President Obama will give Republicans another target when he acts alone to extend protections to as many as five million undocumented immigrants.

JOHN BOEHNER:

We're going to fight the president tooth and nail.

MITCH MCCONNELL:

It's like waving a red flag in front of a bull.

REP. BRAD WENSTRUP (R-OH):

The president may have said, "I hear you," but by the looks of things, it's just the opposite.

CHUCK TODD (V/O)

Republican leaders, hoping to prevent a government shutdown, and to avoid upsetting conservatives, are now considering another option: the courts.

PRESIDENT OBAMA

I would advise rather than devote a lot of time trying to constrain my lawful actions, as the chief executive of the U.S. government in charge of enforcing our immigration laws, that they spend some time passing a bill.

CHUCK TODD (V/O)

Now instead of worrying about shoring up red state incumbents, the president is working on firing up base Democrats who stayed home on Election Day, contributing to the lowest overall midterm turnout in more than seven decades. That may mean picking a fight with members of his own party, as Democratic soul searching revives a rift between moderates and progressives. The first skirmish in the battle to define the party's future, a Senate vote next week on the Keystone Pipeline.

MARY LANDRIEU:

I'd like to vote on Keystone now.

PRESIDENT OBAMA:

Understand what this project is. It is providing the ability of Canada to pump their oil, send it through our land, down to the Gulf, where it will be sold everywhere else. It doesn't have an impact on U.S. gas prices.

(END TAPE)

CHUCK TODD:

Well, the panel is here. I want to start with Keystone. Chris Matthews, the president, is he going to veto it? And is that a death knell for Mary Landrieu?

CHRIS MATTHEWS:

I think this time around, he'll veto. But it's going to come back again and again. And it's one of things that will end up being negotiated.

CHUCK TODD:

Is it a mistake to veto it?

CHRIS MATTHEWS:

Well, he may feel he has to do it for his environmental supporters. But it's not going to stop it. It's going to happen. It will happen. It'll happen now or next year or the year after. Because the country wants jobs and energy is always a primary concern of the American people. And look who are the swing electorate? Working-class whites.

These are the people that Hillary Clinton will want, the Republicans will want. These people are going to be for jobs like this. He said, "There's nothing in it for us." There are jobs in it. And that's the way the American people look at it. Not energy, jobs.

CHUCK TODD:

Helene Cooper, are you surprised at this more energized President Obama?

HELENE COOPER:

I'm not. I think it's really interesting though because somebody clearly didn't tell him that his party got whipped.

CHUCK TODD:

Yeah. It wasn't close.

HELENE COOPER:

Yeah. So it's really interesting seeing just how he's come out. He's clearly now shooting for the fences. He's thinking about his legacy. He wants to get things done. I think that's why you're going to see him doing much more things on the international stage, where he has more ability. And I think, you know, for all of the nice talk that you heard, you know, the day after the election about trying to get along, that's not going to happen. I think we're in for two years of complete gridlock.

CHUCK TODD:

So Carly Fiorina, what should Republicans do if the president, you know, wants to basically still enact his agenda and not let the midterms interrupt that? How should Republicans respond?

CARLY FIORINA:

Well, first, just on Keystone Pipeline, perhaps the president will veto this. But on what basis would he do so? The American people support it by wide majorities. What we are doing today is actually worse for global greenhouse gas emissions than the Keystone Pipeline would be. It would create jobs despite his bizarre statement that it wouldn't. And finally, two and a half years--

CHUCK TODD:

There have been some mixed studies on this. I mean, there's temporary jobs and then there's full-time jobs.

CARLY FIORINA:

Two and a half years of a process, that's either purposeful foot dragging or it's incompetence. And the American people know that. I think what the Republicans should do is soberly and systematically pass bills that make sense, that have bipartisan support. And Keystone XL Pipeline is one of them. They should pass it. If he jumps in and does this executive action on immigration, I think Republicans should not be goaded into--

CHUCK TODD:

Showdown?

CARLY FIORINA:

Showdown. Because it only help Obama and hurts the American people. But what they should do is systematically and soberly pass a series of bills to solve a decades-old problem. And they should point out to Hispanics all over this nation that this president has taken advantage of them. He sunk comprehensive immigration reform in 2007. He did nothing to push forward immigration reform when he had the Senate, the House, and the White House. He said in '11 and '12 he couldn't do anything. And then he delayed his action for the elections. Unbelievable cynicism.

CHUCK TODD:

Reid, it does appear as if the president is looking at different Democratic constituency groups. And when in doubt, going to the base.

REID WILSON:

And your point earlier that this is the beginning of a feud between the two factions of the Democratic party, he's absolutely correct.

CHUCK TODD:

You think there is? Yeah.

REID WILSON:

I mean, I think it's more valuable for Mary Landrieu to be against President Obama and have him veto the Keystone Pipeline than it is for her to actually be able to deliver it. I mean, here we are fully--

CHUCK TODD:

Do you think that's better politics for Mary Landrieu?

REID WILSON:

It certainly is. In a state where President Obama--

(OVERTALK)

CHUCK TODD:

If she can't get something that she wants to get done done, that's good for her?

REID WILSON:

She's not going to be able to convince voters that she's not President Obama's vote. You know, another vote for President Obama. This is the constant problem that Democrats across the country had. They were too closely tied to him. Why not do everything possible to distance yourself from the White House?

CHUCK TODD:

So a veto might help her? No?

REID WILSON:

Look, she doesn't have great chances either way.

CHUCK TODD:

All right, all right. Either way. Yeah.

HELENE COOPER:

But that's--

CHRIS MATTHEWS:

It all happens before December 12th, too. In ten days, they're going to have the veto one way or the other. It's going to happen. We'll have the verdict.

CHUCK TODD:

All right. You guys are coming back. We're going to talk a little bit more about this coming up. Democrats stayed home on election day. Can they reassemble that coalition that elected President Obama twice if he's not on the ballot? On Meet the Press, our Nerd Screen segment is next.

***Commercial Break***

CHUCK TODD:

Well, the Democratic party's prospects for 2016 are all about who shows up to vote. One reason President Obama did so well in 2012 was due to minority and youth turnout. In fact, let's take a look at 2012. 72% of that vote was white, 13% black, 10% Hispanic. And 19% of the overall electorate was between the ages of 18 and 29.

Now, here's what we know. Whites voted for Mitt Romney by nearly 20 points, 59-39. But if you look at everybody else, blacks, Hispanics, Asians, the president won that share of the vote 80 to 19. Now, let's take a look at what happened last Tuesday. We all know turnout was pretty low. But the percentage of white voters actually was up compared to 2012, 75%.

Black and Hispanic numbers dropped, and perhaps most significantly, that 18 to 29 year old vote, dropped all the way down to 13% of those who voted. And guess what that did? It helped produce the GOP wave that we saw. In fact, here are two states where a turnout that looked more like 2012 likely would've changed the outcome of the election.

Colorado and North Carolina. In Colorado, Republican Cory Gardner beat the Democratic incumbent Mark Udall by roughly 42,000 votes. Now look at this. Between 2012 and 2014, the youth turnout in Colorado, mostly Democratic voters, dropped from being 20% of the electorate, one in five voters, to 14%. The youth turnout it held steady, guess what? Probably would've produced enough votes to put Udall over the top. Let's take a look at another example, North Carolina.

Republican Thom Tillis beat the Democratic incumbent Kay Hagan by a little more than 45,000 votes. Had the African American turnout been the same percentage of the electorate as it was in 2012, Senator Hagan easily may have won. In fact, it would've produced 56,000 more votes, would've led to a different outcome.

So what does all this mean for 2016? Many have argued that you need someone like Barack Obama at the top of the ballot to get the kind of turnout that favors the Democrats, or at least favored them in '08 and '12. Well, if that's true, the Democrats could have a problem. Barack Obama's not going to be at the top of the ticket.

But the long-term shift in demographics in the United States as a whole probably will help the Democratic party in the next presidential election when turnout will be higher. Experts expect the white vote turnout to be about 69%. And that alone could help almost any Democrat no matter who's at the top of the ticket, even if his name or her name is not Barack Obama.

***Commercial Break***

CHUCK TODD:

And welcome back, a little earlier I discussed the politics of healthcare with Secretary Burwell and Governor Jindal. But what difference has the Affordable Care Act made to the millions of Americans who have signed up for coverage? I asked my colleague Anne Thompson to take a look at two states, Texas and Illinois. They took very different approaches to the law.

(BEGIN TAPE)

ANNE THOMPSON (ON TAPE):

Everything is bigger in Texas. Including the opposition to the Affordable Care Act.

ROBERT MAYFIELD:

And it's going to be more taxes on all the Texas people. I mean, that's a trap if it was one, it seems to me.

ANNE THOMPSON (ON TAPE):

1,000 miles away in the land of Lincoln and the current president, it's also called the ACA and embraced.

KEITH MOON:

The ACA saved us.

ANNE THOMPSON (ON TAPE):

One year later, two states with very different assessments. Robert Mayfield has a sizzling business in Austin, Texas. He owns a burger joint and six Dairy Queens, employing just under 100 people at above minimum wage.

ROBERT MAYFIELD:

We pay $10 an hour to start. We don't have to. We don't do that because we're nice guys. We do that because we get the best people.

ANNE THOMPSON (ON TAPE):

Mayfield wants to expand the business started by his father in 1949. But going over that 100 employee mark means he would have to offer healthcare to most of his full-time workers or pay penalties under the law's employer mandate.

ROBERT MAYFIELD:

These costs the government imposes on a business, they don't come out of the air. You know, if we have to pay them, we've got to pass them on, or we don't stay in business.

ANNE THOMPSON (ON TAPE):

And if 30 hours a week is how the law defines a full-time worker, forget expansion. Mayfield says he may have to cut hours or jobs.

ROBERT MAYFIELD:

We've got some people that I care very much about that have worked for us ten, 12 years. You know, what do I do with them?

ANNE THOMPSON (ON TAPE):

Texas has the highest percentage of uninsured in the nation, some six million people. Only 733,000 signed up for the ACA.

REP. JOHN ZERWAS:

It was just characterized that this is going to be the panacea to our uninsured issues out there. Well, it's not and it never was.

ANNE THOMPSON (ON TAPE):

State Representative John Zerwas says he hears complaints from people who paid more for less coverage. And though Texas rejected the Medicaid expansion, this Republican doctor is open to other ways.

REP. JOHN ZERWAS:

There is the possibility to look at ways of how we provide insurance for some kind of program available to this million, million and a half people. For which there's not an option for right now.

ANNE THOMPSON (ON TAPE):

In Washington, the incoming Republican majority vows to repeal the law. Fighting words in Keith Moon's house outside Chicago.

KEITH MOON:

If you don't want to repeal this law and the people that won't extend Medicaid, they sit there with insurance, you go without insurance for two years and tell me how you feel.

ANNE THOMPSON (ON TAPE):

Moon's family did after he and his wife Joyce lost their jobs. Joyce's pre-existing thyroid condition pushed the price tag for insurance to an unaffordable $1,750 a month.

ANNE THOMPSON:

As a husband, your wife isn't getting the attention she needs.

KEITH MOON:

It was terrible. You felt awful about that.

ANNE THOMPSON (ON TAPE):

Now with the ACA, they pay $300 a month. And Joyce gets the care she needs.

ANNE THOMPSON:

One year later, what's the emotional difference?

KEITH MOON:

You don't have that overhanging stress and risk of medical bankruptcy. So you have that burden lift from your shoulders is just, I don't even know how to put it in words.

ANNE THOMPSON (ON TAPE):

In Illinois, of the 1.2 million people eligible, more than 700,000 signed up.

BRIAN GORMAN:

Because of the coverage in the Affordable Care Act, a lot of people are more likely to live. Families are less likely to go bankrupt.

ANNE THOMPSON (ON TAPE):

Entering year two, the Affordable Care Act has not healed the divide it created. For Meet the Press, Anne Thompson.

(END TAPE)

CHUCK TODD:

Now for a deep dive on the policy, I'm joined by Dr. Toby Cosgrove, head of the Cleveland Clinic, Neera Tanden, President of the Center for American Progress. She worked with the White House and in the White House to developed President Obama healthcare law, and Avik Roy, he's a senior fellow at the Manhattan Institute for Policy Research and opinion editor for Forbes, who advised Mitt Romney on healthcare. Welcome to all of you. Dr. Cosgrove, let me start with you. Affordable Care Act, is it working?

DR. TOBY COSGROVE:

Well, we've seen several good things happen. It's really started out to decrease the cost. And the jury's not in on that yet. And you have to understand that costs are not just about the individual. They're also about the cost for healthcare across the nation. It certainly has improved.

CHUCK TODD:

And you, as the head of the Cleveland Clinic, you would know.

DR. TOBY COSGROVE:

Well, we certainly have seen that, yes.

CHUCK TODD:

And so you feel like costs have come down?

DR. TOBY COSGROVE:

We are working very hard to bring costs down. We realize that the pressure is on healthcare providers across the country to try and make care more affordable and greater efficiency, and at the same time, bring up quality. And we've seen the national quality indicators go up and we certainly have seen access increased across the country. So there are the main thing that we're seeing is the jury is not in yet on how we're doing as far as costs across the country is concerned.

CHUCK TODD:

Avik?

AVIK ROY:

Hospital costs are going up.

CHUCK TODD:

But I was just going to say, first year, is it not the doom and gloom that was predicted?

AVIK ROY:

Well, so hospital costs and the underlying cost of insurance for people to buy coverage on their own did go up in year one for ObamaCare. It's stable this year from those higher levels. But a big part of what's happening that a lot of people haven't been paying attention to is as more people are on Medicaid and Medicare, the big government insurance plans, hospitals across the country are merging in order to have higher market power to raise prices on people with private insurance.

And thereby increase premiums for people with private insurance. We're seeing that actually in Northeastern Ohio, the Cleveland Clinic recently merged with the hospital system in Akron. Now, Toby's situation might be an exception. But in general, these mergers have led not so much to increased quality, but to higher prices. On average, 44% higher prices for things like knee replacements and angioplasty and heart surgery compared to what they were like in competitive markets in the old days.

CHUCK TODD:

Neera, you're shaking your head.

NEERA TANDEN:

Just to clarify, we actually have data on these things. And premiums, national premiums, are coming down. Premiums that people are paying, your out-of-pocket costs are actually coming down. We used to have double-digit increases over the last couple years, those come down. So it's true that the healthcare system is transforming itself, because there is a lot of pressure to bring costs down.

There is greater concentration in some areas. Sometimes, and in most of those cases, the world we're seeing is that there's better value for the patient. So I'm happy to discuss the ins and outs of particular areas, but as a national plan, we have national numbers and medical inflation is down. And it's translating into lower premium increases.

CHUCK TODD:

Dr. Cosgrove, what's the next metric?

DR. TOBY COSGROVE:

Well, the metrics are going to be around quality transparency and the transparency around costs. And we're going to see both of those happen over time. And that will bring the marketplace to a real marketplace. We need to have people understand and have a part in how much they are paying for their health care. And we really need to move from sick care to well care.

And that's going to require that people get involved in their care and understand what they're doing. And at the end of the day, you have to understand that the health of the country is only as good as the health of its citizens. And we need to work on that hard.

CHUCK TODD:

Avik, what would you be advising Republicans to do right now? Do you try to dismantle the law, or do you try to improve it?

AVIK ROY:

I think you try to make changes to the law based on things that you think the president can sign, whether it's bipartisan support.

CHUCK TODD:

So you wouldn't be going for the kill on this?

AVIK ROY:

No, I mean, they're going to have a vote on repeal, because the base really wants it. They've made that promise to the voters, and that's fine. But Republicans in the next two years really have to start thinking constructively about how to make the healthcare system better. One of those is to increase access to coverage, access to care.

But a big part of how you increase access to care is to make it less expensive. The average day spent in a hospital in the United States costs five times what it does in the typical industrial country. That's way too high. And it's not enough to just say, "Okay, we're increasing hospital costs by 2% or 3% next year." We've got to bring it down.

CHUCK TODD:

And Neera, that's one part of this law that didn't, you know, it really focused on insurance coverage. It was having a harder time to go after the cost.

NEERA TANDEN:

Well, we do have national health expenditures that have been lowering. And I think that's in part because of the ACA, but a lot of other factors as well.

CHUCK TODD:

Sure, economics.

NEERA TANDEN:

You know, the economic downturn has had some pressure as well. I think the thing that we have to distinguish is that out-of-pocket costs have been going up for consumers. That's a ten-year trend. Those employers have been shifting. So I think that's the next area for Democrats, I hope Republicans, the next area to really concentrate on. How much consumers are paying. The law has actually had a big benefit here because premiums are coming down. But people have to, you know, that's a huge issue for all people.

CHUCK TODD:

Very quickly.

DR. TOBY COSGROVE:

We have to understand also we're going to have a shortage of doctors and nurses. 800,000 nurses in a decade and another 130,000 doctor shortage. And we have to address that before it gets to be a real crisis.

CHUCK TODD:

All right, Dr. Cosgrove, Avik Roy, Neera Tanden, a little substance with people's Sunday morning breakfast we thought would be good--

(OVERTALK)

CHUCK TODD:

--a little policy-wonkish. Thank you all for this. We'll be back in 15 seconds with more from the political panel.

***Commercial Break***

CHUCK TODD:

And welcome back. The panel is still here. And I want to pick up on quickly on the healthcare conversation. Carly Fiorina, would you be advising for repeal at this point in time? And do you think at some point, you've got to almost stop talking about repeal, or no?

CARLY FIORINA:

I think that the Republican House will pass the bill that repeals it. I think ultimately this bill does need to be repealed.

CHUCK TODD:

And you don't think the Senate will?

CARLY FIORINA:

No, I don't think the Senate will. Let me tell you why I think it needs to be repealed utilities. You know, what happens when you have vast legislative overreach is you don't particularly fix the problem you started out to fix and you create problems for everyone else. And that's what we've done.

The number of uninsured isn't coming down fast enough. Preexisting conditions, I'm a cancer survivor. Of course that should not be a reason not to get health insurance, but they keep talking about premiums. What they don't talk about is everyone's deductibles have gone up. What they don't talk about is not enough people are getting insured. And very created so many other problems. You referenced Jonathan Gruber before. This law is longer than a Harry Potter novel. It's been accompanied of tens of thousands of paper regulation.

CHUCK TODD:

But shouldn't have--

(OVERTALK)

CHUCK TODD:

I never understood the--

CARLY FIORINA:

Of course nobody understands it.

CHUCK TODD:

But in the health--

CARLY FIORINA:

It created problems for everyone.

CHUCK TODD:

But of course, the healthcare, you're going to write a big, long law. Or you don't?

CARLY FIORINA:

Well, or, you can go to the one force that we know reliably improves quality and lowers costs and it's called competition. The health insurance market has never been competitive. It was crony capitalism, the way this bill was written between the health insurance companies trying to protect their franchises and big government.

CHUCK TODD:

Well, Reid Wilson, you helped me a lot on my book, Stranger. And when went through the healthcare thing, clearly passing the bill became more important than sometimes the words in the bill.

REID WILSON:

It did. And within the White House, there was a lot sort of overcorrection for the mistakes that the Clintons had made. They ceded a lot of power, a lot of writing authority to Capitol Hill. That didn't work because of some internal dynamics within the Democratic Conference up there especially in the Senate. So this is, you know, a political problem for the president. From the first day of his administration, it has plagued him. And it will continue to do so in the last two years of his serve.

CHUCK TODD:

You know, Chris Matthews, if you're the administration, you know, Sylvia Burwell admitted, they still haven't marketed health care very well.

CHRIS MATTHEWS:

I agree with that. But I want to go back to the basis, the genesis of this bill. And it's the same as the fight over immigration. As long as you have an intractable opposition, I mean, I was hoping we could get Orrin Hatch on this health care bill. I was hoping that Mike Enzi, these are all good people, they were negotiating. They all fell off because of fear of the tea party people. Same with immigration. Please God have a meeting between the president and the speaker in the House this week before this--

(OVERTALK)

CHUCK TODD:

You think they need to meet before?

CHRIS MATTHEWS:

Meeting in public. I'd like it on television. What is your opposition to this immigration bill? Is it we don't have enough enforcement? I'll give you more enforcement. Is it hiring rules? We're going to enforce them. I promise you we're going to enforce them. What do you want? So you're absolutely against any kind of amnesty for people who have been here 20, 30 years, absolutely against it?

So what then when the president issues the executive order, people will understand he really tried to negotiate. Let me tell you something, we're negotiating with Tehran right now. We're desperately trying to cut a deal over nuclear weapons to the last moment. Why don't we have negotiations going on right now between the two sides?

CHUCK TODD:

You know, he brings up a point, and I can hear Republicans now echoing, he'll negotiate with the Iranians, he won't negotiate with us on immigration.

HELENE COOPER:

I think though for the Republicans, though, there's also--

CHRIS MATTHEWS:

That's not the way I said it.

CHUCK TODD:

No, I'm telling you how you're going to get requoted.

CHRIS MATTHEWS:

Right.

CHUCK TODD:

No, you and I both know that.

HELENE COOPER:

You're right. You're absolutely right.

CHUCK TODD:

No, that's how he's going to get requoted.

(OVERTALK)

CHRIS MATTHEWS:

But they want to negotiate though, Chuck.

(OVERTALK)

CHRIS MATTHEWS:

Well, they need to tape more television shows. What's their opposition to immigration? I'm sorry, Helene.

CHUCK TODD:

Very quick.

HELENE COOPER:

I think that for the Republicans, there's going to be a danger of overreach as well. Because they right now control the Senate and if they're going to go and shut down the government over an immigration bill, they're going to go after repealing healthcare, what are they going to be for?

CHUCK TODD:

Well, that's what they have to figure out. Alright, before I let you go, we thought we'd end on a happy note. The president of course is on his way home from the G20 summit in Australia. Reportedly, there were some edgy exchanges of course and some meetings between the leaders, Russian President Putin.

But being Australia, the host brought out some cuddly koalas to relieve any tension as the summit ended. Well, look at that. Putin and a koala. This is like him posing with an animal that wasn't faked, by the way. There's the president, almost getting tickled by a koala. Is this just a reminder that just everything goes better with animals? Right? Everybody's in a happier mood when--

CHRIS MATTHEWS:

You want an Irish joke?

CHUCK TODD:

Yeah, go quick.

CHRIS MATTHEWS:

Okay.

CHUCK TODD:

Uh-oh.

CHRIS MATTHEWS:

An Irishman is trying to get through immigration. The guy says, "Do you have a criminal record?" He said, "No, is it still required?"

CHUCK TODD:

Oh, ouch. Ouch. Carly Fiorina, before I let you go, how serious are you about running for president?

CARLY FIORINA:

That'll be something I consider at the right time.

CHUCK TODD:

So are you considering?

CARLY FIORINA:

Well, when people ask you over and over again, you have to pause and reflect. So I'll pause and reflect at the right time.

CHUCK TODD:

So that means it's something you're pondering? You're going to go Iowa soon?

CARLY FIORINA:

You have to ponder when people keep asking. And I've been to Iowa plenty to help women engage and isn't it fantastic that Joni Ernst won?

REID WILSON:

There's a direct flight out of DCA now.

CHUCK TODD:

All right. That's all for today. We'll be back next week because if it's Sunday, it's Meet the Press.

* * *END OF TRANSCRIPT* * *