House Democratic Leader Nancy Pelosi sat down with doctors and staff at University Medical Center on Tuesday to discuss their lifesaving efforts following a mass shooting on the Las Vegas Strip earlier this month and seismic changes to the health-care policy landscape under the Trump Administration.

Pelosi, the long-serving leader of the House Democrats who was a driving force in getting the original Affordable Care Act passed in 2010, spent much of the time stressing the need to keep the law’s key provisions. Officials at the public hospital told her they’ve seen the rate of uninsured patients they serve drop substantially after Medicaid was expanded under Obamacare, and the institution’s finances have stabilized after being on the brink as a result.

Some of the 20 or so attendees at the roundtable said the Oct. 1 tragedy finally brought a spotlight to the hospital, the state’s only Level 1 trauma center but also a public institution that must care for people who have no ability to pay. None of the Las Vegas shooting victims who were alive when they arrived at UMC later died.

But they appealed to the powerful lawmaker to keep working for the financial good of the hospital, saying that the spirit and collaboration they showed after the shooting can only take things so far.

Here are highlights from Pelosi’s stop:

Praise for Rep. Ruben Kihuen

Pelosi, from California, was in town for a closed-door fundraiser for Democratic congressional candidates Susie Lee and Rep. Ruben Kihuen.

She had high praise for the freshman Kihuen, who is seeking re-election in the Democratic-leaning but sometimes swingy 4th Congressional District. His likely Republican opponent is Las Vegas City Councilman Stavros Anthony.

“Ruben came in really effective from the start. Geared up, knowledgeable, curious, effective,” Pelosi told the attendees as Kihuen sat beside her at the roundtable.

She also underscored Kihuen’s personal story. After emigrating from Mexico at the age of 8, his family’s legal status lapsed for a time, making him one of two former “DREAMers” in Congress.

“His story is so remarkable. His empathy is so great,” Pelosi said.

While the Democratic leader is working to help other House members keep their seats, she faces challenges of her own. Fellow Democrats have openly discussed replacing her, especially as the party has lost ground in the House and fell short in a series of recent special elections across the country, although a viable replacement has yet to emerge.

Opponents in Nevada and elsewhere have used the San Francisco congresswoman as a symbol of coastal liberal elites and tried to tie endangered candidates to her.

“Susie Lee and Ruben Kihuen may be the toast of the out-of-touch Democratic establishment, but rest assured: while they clink glasses with Nancy Pelosi, their constituents are watching,” National Republican Congressional Committee spokesman Jack Pandol said in a statement. “Susie and Ruben will need every penny Nancy gives them to defend themselves from her toxic, far-left brand voters have rejected.”

As for a Pelosi ouster, Kihuen said it wasn’t the time to be discussing a leadership change.

“Right now, this Congress should be focused on getting our priority bills passed — making sure that the Affordable Care Act is protected, making sure we have bipartisan tax reform if that’s going to happen, and getting the Dream Act passed and that we start talking about infrastructure,” he told The Nevada Independent. “I don’t believe right now we should be doing anything else that would distract us from those things.”

A fix for Trump’s strikes at Obamacare

Pelosi was critical of President Donald Trump’s announcement last week that he would end Obamacare’s cost sharing reduction payments, which subsidize insurance companies so they can provide coverage to low-income people. The move to eliminate the payments, which amount to about $7 billion a year, was roundly criticized by Gov. Brian Sandoval and others as something that would prompt insurers to withdraw from exchanges and increase premiums overall.

Trump had characterized the payments as a bailout to insurance companies.

“I don’t think he understood the fear it would instill in people to say we’re not doing it and it’s just for insurance companies,” Pelosi told reporters at UMC. “This is a market-oriented, Affordable Care Act — how to help people afford their insurance and their care. This is actually a Republican idea. So for him to characterize it that way was foolish.”

While she said she hadn’t been fully briefed on the plan, she sounded a positive note about a bipartisan fix announced Tuesday that would continue the cost-sharing reduction payments for two years and allow states more flexibility under Obamacare. The deal was struck between Republican Sen. Lamar Alexander and Democratic Sen. Patty Murray.

“We trusted Patty with our values. We have shared values and we’ve been fighting this fight for a long time with the Affordable Care Act,” Pelosi said. “We had confidence, even though it was a Senate procedure.”

She expressed disappointment with House Republicans for failing to come up with a plan in the lower chamber, saying Speaker Paul Ryan said “our people are still smarting from the defeat in the Senate.”

“Now that the Senate’s doing something, that places it in a different place,” she said. “But if you were speaker, why would you want the other body to write the bill except that your people just don’t want to do it?”

Medicaid Expansion

The Democratic leader had high praise for Sandoval’s decision to expand Medicaid under the Affordable Care Act and his recent opposition to a repeal bill co-sponsored by Nevada Republican Sen. Dean Heller.

“He was very helpful in his statements and the rest on Graham-Cassidy,” Pelosi said, referring to the bill Heller co-sponsored. “That was a very damaging bill.”

She described him as a “resource” who helped persuade others not to buy into the bill and said he’d worked with her on fixes.

“He wanted some flexibility on the Medicaid and that’s what’s in the bill, except not to the disadvantage of the very poor and the very sick,” she said.

Clark County Commissioner Lawrence Weekly, who chairs UMC’s board of trustees, urged Pelosi to stay engaged with Sandoval on fixes to Obamacare — a bill he called “a blessing” to the hospital.

“We also need to keep an open ear to him as a Republican governor,” Weekly said. “We can’t repeal without anything to replace it with and he may have some ideas that may resonate with some members of his party.”

The case for Obamacare

Pelosi made a full-throated defense of the Affordable Care Act (ACA), arguing that it was more than a program to help the poor and helped slow the pace of cost hikes for insurance in all socioeconomic brackets.

“If there was no other reason to pass Obamacare — if everyone loved their insurance, their insurer — the costs were unsustainable, to individuals, to families, to small businesses, to corporate America, hospitals, county state local and federal officials,” she said of insurance markets before the ACA.

Although Obamacare’s most-cited beneficiaries are the uninsured who newly got coverage, the 120 million or so people who get insurance through their employers are now entitled to essential health benefits: no cost caps, no obstacles for people with pre-existing conditions, the ability to stay on a parent’s insurance until the age of 26.

“They got so much more than what they had and lowered the rate of increase,” Pelosi said. “But we didn’t sell it. So people thought, I’m spending more so somebody who’s poor is getting money.”

President Barack Obama was partly to blame, she said.

“The other side came in with hundreds of millions of dollars to misrepresent what it was,” she said. “Bless his heart, President Obama — fabulous and great in every way, an inspiration. But he — we kept saying ‘air cover, air cover.’ But we were too busy getting the job done to explain the money.”

She also made the case that Obamacare spending is a jobs bill that keeps rural hospitals open, thus attracting business to less-developed areas. Spending on hospitals and schools, she said, should be on par with spending on roads, bridges and broadband.

“We’ve got to look at hospitals as part of infrastructure,” she said.

Tax reform

Pelosi had strong words for Republicans’ push to overhaul the tax code, describing it not as a tax cut but as an irresponsible expenditure.

She said the cuts for the wealthy and corporations would cost the country about $3 trillion when debt service is factored in, and brushed aside the Republican case that the tax cuts would accelerate economic growth and make up for the foregone revenue.

“They say all the growth will return to the treasury. It never has. Trickle-down economics never has,” she said.

The plan would force budget cuts to education, health care and other things that would “greatly diminish” the nation’s future growth prospects.

“It will change who we are as a country,” she said. “This, for us, is Armageddon.”