The President on “Tweak[ing]” The Affordable Care Act

August 9th, 2013

During the President’s remarks today, which mainly focused on national security, he offered several comments about the Affordable Care Act.

One question was posed about the delay in the business mandate.

Q: OK, thank you. I want to ask you about two important dates that are coming up. October 1st, you’re going to implement your signature health care law. You recently decided on your own to delay a key part of that. And I wonder, if you pick and choose what parts of the law to implement, couldn’t your successor down the road pick and choose whether they’ll implement your law and keep it in place?

With respect to health care, I didn’t simply choose to delay this on my own. This was in consultation with businesses all across the country, many of whom are supportive of the Affordable Care Act, but — and who — many of whom, by the way, are already providing health insurance to their employees but were concerned about the operational details of changing their HR operations if they’ve got a lot of employees, which could be costly for them, and them suggesting that there may be easier ways to do this.

That is a serious, gross understatement of the objections. Businesses, and prominent supporters of the ACA such as Ezra Klein, want this mandate repealed. “Operational details” were the tip of the ice berg. But the President’s next answer is revealing.

Now what’s true, Ed, is that in a normal political environment, it would have been easier for me to simply call up the speaker and say, you know what? This is a tweak that doesn’t go to the essence of the law. It has to do with, for example, are we able to simplify the attestation of employers as to whether they’re already providing health insurance or not. It looks like there may be some better ways to do this. Let’s make a technical change of the law.

That would be the normal thing that I would prefer to do, but we’re not in a normal atmosphere around here when it comes to, quote- unquote, “Obamacare.”

Optimized-Final-CoverLet’s go back to late 2009 and early 2010 when the ACA cleared the House. The President had no interest in calling the Speaker or the Minority Leader at that time. He was content to pass the ACA on a straight party line vote. All the Democrats were (I have an entire chapter in my book on this). The ACA was the only act of major legislation passed in the 20th Century without *any* bipartisan support. It was as if there was some cognitive dissonance, that once the law is passed, everything will be groovy. Who cares if 49% of the House opposes it. Well, that wasn’t the case then. And there years later, it isn’t the case now. The Republicans have engaged in brutal political fights over this law, and have showed no signs of cooperating. The President should not be surprised that the Republicans refuse to give an inch after the history, where he wrote them off.

So now, in this “political environment,” what is the President to do? The same thing he has done with many other situations where Republicans would not get along.

We did have the executive authority to do so, and we did so. But this doesn’t go to the core of implementation.

The President has construed his executive authority quite broadly.

Here are the rest of the President’s remarks on health care. A few interesting nuggets.

Let me tell you what is the core of implementation that’s already taken place. As we speak, right now, for the 85 percent of Americans who already have health insurance, they are benefiting from being able to keep their kid on their — on their plan if their kid is 26 or younger. That’s benefiting millions of young people around the country, which is why lack of insurance among young people has actually gone down. That’s in large part attributable to the steps that we’ve taken. You’ve got millions of people who’ve received rebates because part of the Affordable Care Act was to say that if an insurance company isn’t spending 80 percent of your premium on your health care, you get some money back. And lo and behold, people have been getting their money back. It means that folks who’ve been bumping up with lifetime limits on their insurance that leaves them vulnerable — that doesn’t exist. Seniors have been getting discounts on their prescription drugs. That’s happening right now. Free preventive care, mammograms, contraception — that’s happening right now.

I met a young man today on a bill signing I was doing with the student loan bill who came up to me and said, thank you — he was — he couldn’t have been more than 25, 26 years old — thank you; I have cancer; thanks to the Affordable Care Act, working with the California program, I was able to get health care, and I’m now in remission. And so right now people are already benefiting.

Now, what happens on October 1st, in 53 days, is for the remaining 15 percent of the population that doesn’t have health insurance, they’re going to be able to go on a website or call up a call center and sign up for affordable, quality health insurance at a significantly cheaper rate than what they can get right now on the individual market.

And if, even with lower premiums, they still can’t afford it, we’re going to be able to provide them with a tax credit to help them buy it. And between October 1st, end of March, there will be an open enrollment period in which millions of Americans for the first time are going to be able to get affordable health care.

Now, I think the really interesting question is why it is that my friends in the other party have made the idea of preventing these people from getting health care their holy grail. Their number-one priority. The one unifying principle in the Republican Party at the moment is making sure that 30 million people don’t have health care; and presumably, repealing all those benefits I just mentioned — kids staying on their parents’ plan, seniors getting discounts on their prescription drugs, I guess a return to lifetime limits on insurance, people with pre-existing conditions continuing to be blocked from being able to get health insurance.

That’s hard to understand as a — an agenda that is going to strengthen our middle class. At least they used to say, well, we’re going to replace it with something better. There’s not even a pretense now that they’re going to replace it with something better.

Q: (Off mic) —

PRESIDENT OBAMA: The — the — the notion is simply that those 30 million people, or the 150 million who are benefiting from the other aspects of affordable care, will be better off without it. That’s their assertion, not backed by fact, not backed by any evidence.

It’s just become an ideological fixation.

Well, I’ll tell you what — they’re wrong about that. There is no doubt that in implementing the Affordable Care Act — a program of this significance — there are going to be some glitches. No doubt about it. There are going to be things where we say, you know what? We should have thought of that earlier, or this would work a little bit better or this needs an adjustment. That was true of Social Security. That was true of Medicare. That was true of the children’s health insurance program. That was true of the prescription drug program part D that was rolled out by a Republican president and supported by Republicans who are still in the House of Representatives.

That’s true, by the way, of a car company rolling out a new car. It’s true of Apple rolling out the new iPad. So, you know, you will be able to, whenever you want, during the course of the next six months and probably the next year, find occasions where you say, aha, you know what? That could have been done a little bit better, or that thing — they’re kind of making an administrative change. That’s not how it was originally thought this thing was going to work.

Yes, exactly, because our goal is to actually deliver high- quality, affordable health care for people and to reform the system so costs start going down and people start getting a better bang for the buck. And I make no apologies for that.

And let me just make one last point about this. The idea that you would shut down the government unless you prevent 30 million people from getting health care is a bad idea. What you should be thinking about is, how can we advance and improve ways for middle class families to have some security so that if they work hard they can get ahead and their kids can get ahead.

Instead of tweaking, Obamacare, I think it would be much more entertaining to twerk it.