During the 2009 Netroots Nation convention held in Pittsburgh, PA, Massa told a group of activists that he "will vote adamantly against the interests of my district if I actually think what I am doing is going to be helpful" in regard to a single-payer health care system. Moments later Massa clarified that he meant he would vote against the "opinions" of his constituents if he thought it was the right thing to do. He also controversially exclaimed that Sen. Chuck Grassley's comments describing end-of-life care as "killing Grandma" constitute "an act of treason."