Here are some of the highlights of the President’s remarks before the Catholic Hospital Association.

The President’s first substantive comment was correct:

And pursuing health care reform wasn’t about making good on a campaign promise for me.

As I discuss in Unprecedented, health care wasn’t a campaign promise. He in fact attacked Hillary Clinton’s proposal, which he ultimately adopted as the ACA after he was elected.

Next the President discusses the political obstacles to passing the law:

And it seemed like an insurmountable challenge.  Every time there was enough political will to alleviate that suffering and to reform the health care system — whether it was under Democratic Presidents or Republican Presidents — you had special interests arraying and keeping the status quo in place.  And each year that passed without reform the stakes kept getting higher. … And so we determined that we could not keep kicking that can down the road any longer.  We could not leave that problem for another generation to solve, or another generation after that.

He acknowledged those who told him it was “too messy.”

And remember, this was not easy.  (Laughter.)  There were those who thought health care reform was too messy, and too complicated, and too politically risky.

His next sentence is very subtle, but alludes to the plan cancellations:

I had pollsters showing me stuff, and 85 percent of folks at any given time had health care and so they weren’t necessarily incentivized to support it. And you could scare the heck out of them about even if they weren’t entirely satisfied with the existing system that somehow it would be terrible to change it.  All kinds of warning signs about how tough this was — bad politics.

What he is alluding to is the fact that before the ACA, roughly 80% of Americans were happy with their health insurance. In order to pass the bill, the President had to repeat over and over again the lie that people could keep their policies if they like them. This was his way of countering opponents who would “Scare the heck out of them … that somehow it would be terrible to change it.” As Stephen Brill recounts in his book, his administration made the decision to simply mislead the American people about this, hoping that when people get better policies, they wouldn’t mind that their previous plans were cancelled. It seems he still hasn’t learned this lesson, and views the ends as justifying the means.

The President then repeats a common refrain–health care is not a commodity but a fundamental right.

Behind every single story was a simple question:  What kind of country do we want to be?  Are we a country that’s defined by values that say access to health care is a commodity awarded to only the highest bidders, or by the values that say health care is a fundamental right?  Do we believe that where you start should determine how far you go, or do we believe that in the greatest nation on Earth, everybody deserves the opportunity to make it — to make of their lives what they will?

Next, in a direct rebuke of Herbert Hoover’s philosophy “rugged individualism,” the President speaks in terms of a “Shared set of values.”

The rugged individualism that defines America has always been bound by a shared set of values, an enduring sense that we’re in this together, that America is not a place where we simply turn away from the sick, or turn our backs on the tired, the poor, the huddled masses.  It is a place sustained by the idea:  I am my brother’s keeper.  I am my sister’s keeper — that we have an obligation to put ourselves in our neighbor’s shoes and see each other’s common humanity.

He dismisses all of the calls that the sky would fall, and touts some of the immediate benefits of the law:

And despite the constant doom-and-gloom predictions, the unending Chicken Little warnings that somehow making health insurance fairer and easier to buy would lead to the end of freedom, the end of the American way of life — lo and behold, it did not happen.  None of this came to pass.  In fact, in a lot of ways, the Affordable Care Act worked out better than some of us anticipated. Nearly one in three uninsured Americans have already been covered — more than 16 million people -– driving our uninsured rate to its lowest level ever.  (Applause.)  Ever.  On top of that, tens of millions more enjoy new protections with the coverage that they’ve already got.

He repeats that the 85% of Americans who liked their health insurance now have something better–they’re just too stupid to realize it.

That 85 percent who had health insurance, they may not know that they’ve got a better deal now than they did, but they do.

Although note that at the Catholic Hospital Association, he mentions preventative service for women like mammograms–not aboritfacients.

Women can’t be charged more just for being a woman.  (Applause.)  And they get free preventive services like mammograms

The President sketches what became known as the Life of Julia campaign, where the government cares for you from the cradle to the grave:

And here’s the thing — that security won’t just be there for us.  It will be there for our kids as they go through life.  When they graduate from college, they’re looking for that first job, they can stay on our plans until they’re 26.  When they start a family, pregnancy will no longer count against them as a preexisting condition.  When they change jobs or lose a job, or strike out on their own to start a business, they’ll still be able to get good coverage.  They’ll have that peace of mind all the way until they retire into a Medicare that now has cheaper prescription drugs and wellness visits to make sure that they stay healthy.

Cradle to the grave.

The President noted several people who benefited from the laws in Texas and Tennessee–both Red states that did not establish an exchange, and presumably may lose their subsidies .

In reality, there are parents in Texas whose autistic son couldn’t speak.  Even with health insurance, they struggled to pay for his treatment.  But health reform meant they could buy an affordable secondary plan that covered therapy for their son — and today, that little boy can tell his parents that he loves them.  That’s the reality.  (Applause.)

In reality, there’s a self-employed barber from Tennessee — who happens to be a Republican — who couldn’t afford health insurance until our new marketplace opened up.  And once he bought a plan, he finally went to the doctor and was diagnosed with esophageal cancer.  In the old days, without coverage, he wouldn’t have even known that he was sick.  And today, he’s now cancer-free.

Now the President turns to the heart of the matter, and sends a clear message–Obamacare is here to stay:

So five years in, what we are talking about it is no longer just a law.  It’s no longer just a theory.  This isn’t even just about the Affordable Care Act or Obamacare.  This isn’t about myths or rumors that folks try to sustain.  There is a reality that people on the ground day to day are experiencing.  Their lives are better.

I agree in one limited respect. It isn’t a law. It has become bigger than the law, or the rule of law itself. The goals of healthcare reform have trumped the separation of powers. Read the Amicus I submitted in King v. Burwell for more.

The President continues that the ACA is part of the “fabric” of our country:

This is now part of the fabric of how we care for one another.  This is health care in America — which is why, once you get outside of Washington and leave behind the Beltway chatter and the politics, Americans support this new reality.  When you talk to people who actually are enrolled in a new marketplace plan, the vast majority of them like their coverage. The vast majority are satisfied with their choice of doctors and hospitals and satisfied with their monthly premiums.  They like their reality.

The use of the word “reality” is interesting, as it suggests anyone who opposes the law remains in fantasyland.

He notes there were “disruptions in the rollout”:

Like any serious attempt at change, there were disruptions in the rollout, there are policies we can put in place to make health care work even better.

And that more Governors need to sign up for Medicaid:

We need more governors and state legislatures to expand Medicaid, which was a central part of the architecture of the overall plan.

He repeats that we should not go “backwards.”

And none of this is going to be easy.  Nobody suggests that somehow our health care system is perfect as a consequence of the law being passed, but it is serving so many more people so much better.  And we’re not going to go backwards.

People can no longer oppose this law because so many benefit from it:

There’s something, I have to say, just deeply cynical about the ceaseless, endless partisan attempts to roll back progress.  I mean, I understood folks being skeptical or worried before the law passed and there wasn’t a reality there to examine.  But once you see millions of people of having health care, once you see that all the bad things that were predicted didn’t happen, you’d think that it would be time to move one.

 

And here it comes–why would anyone want to “unravel” the law:

Let’s figure out how to make it better.  It seems so cynical to want to take coverage away from millions of people; to take care away from people who need it the most; to punish millions with higher costs of care and unravel what’s now been woven into the fabric of America.

History will judge poorly those who oppose the law (can you hear me Mr. Chief Justice):

And that kind of cynicism flies in the face of our history.

Echoing an argument the Solicitor General made during his closing argument in NFIB, the President asserts that Obamacare promotes freedom:

Just as we’ll never go back to a time when seniors were left to languish in poverty or not have any health insurance in their golden years.  There was a generation that didn’t have that guarantee of health care.  We’re not going to go back to a time when our citizens can be denied coverage because of a preexisting condition.  When tens of millions of people couldn’t afford decent, affordable care — that wasn’t a better America.  That’s not freedom.  The freedom to languish in illness, or to be bankrupt because somebody in your family gets stick — that’s not who we are.  That’s not what we’re about.

As Paul Clement responded, this is a very funny conception of freedom to mandate that people buy health insurance.

This will be part of the Pre-decision chapter of my book.