Obama Defiant, Optimistic on Health Care Reform

 Obama Defiant, Optimistic on Health Care Reform

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WASHINGTON, D.C. -- Though “yes we can” and not “win the future” was the enthusiastically chanted slogan that welcomed President Barack Obama to the FamiliesUSA conference on Friday, his remarks on health care reform made it clear the President’s focus is on the implementation of the Affordable Care Act (ACA).

While offering to work with those of either political party who offered constructive recommendations to improve the ACA, and ceding that the process will need a “tweak” here and there along the way, the President was adamant in the legislation’s defense, reprising the few references he made to the ACA in his State of the Union speech only days earlier.

“But here’s what I’m not open to, and I said this Tuesday. I am not willing to just refight the battles of the last two years. I’m not open to efforts that will take this law apart without taking into account the lives and livelihoods that hang in the balance,” Obama said. “FamiliesUSA, we’re moving forward, we are moving forward.”

FamiliesUSA, a non-partisan, non-profit organization dedicated to attaining affordable health care, draws upon the resources of other organizations, community activists, and policy analysts from around the country. It has been among the most aggressive advocates of Obama’s efforts to restructure America’s delivery of health care.

Ron Pollack, the organization’s executive director, commended Obama’s accomplishment. “As you know so well, numerous presidents over many decades tried to secure health reform legislation that would move us toward high quality, affordable health care for all Americans,” Pollack
said. “You, Mr. President, actually achieved it. “

Pollack was in an equally combative mood. On the imminent state by state implementation of the ACA, he said, “We will stand shoulder to shoulder with the President to make sure that no one, absolutely no one, takes away from American families the benefits and rights of the Affordable Care Act.”

A key provision of the ACA requires states, by 2014, to put in place state health insurance exchanges responsible for overseeing the public’s access to health coverage. A recently released report by the non-partisan National Academy of Social Insurance (NASI), was cited by several panelists as an accurate synopsis of the immediate challenges ahead.

States will have to decide whether an exchange will be housed in an existing state agency, or to establish a new one; to set up an independent entity like a non-profit agency, or even to collaborate with other states in multi-state agency. Each choice brings its own unique set of challenges, but a key ACA goal, in part, according to the NASI report, is “to promote effective competition for health insurance by increasing consumer choice and providing transparency on the cost and quality of plans.”

Alan Weil, executive director, National Academy of State Health Policy, during a plenary session prior to Obama’s appearance, explained that regardless of whether governors or legislatures oppose particular provisions of the ACA, they are now legally obligated to enforce federal law. But he also described a political imperative that he felt likely will drive its implementation.

“Medicaid is still the safety net,” Weil said, describing the program designed for low-income Americans, and though it is partially funded through federal dollars, it, as well as the insurance exchange, is administered at the state level. Thus, Weil observed, it will be state officials who will have to contend with program eligibility issues -- like income, for example -- as state agencies or exchanges shift individuals on or off Medicaid and into private health insurance; it will be those same officials who will first bear the brunt of public displeasure if the resulting systems are not well integrated or dysfunctional. “Accountability is going to rest at the state level,” Weil said, adding that states must address consumers’ primary concern: “They want to know how they’re going to get health care.”

In his speech, Obama cast access to health care as part of the American dream, along with employment, sending one’s children to college and having adequate financial resources for retirement.

He particularly honed in on the ACA’s removal of pre-existing medical conditions as a criteria for qualifying for health insurance, citing several examples of families, especially with children, who had unsuccessfully desperately sought coverage from insurers before the ACA was enacted 10 months ago. “You’re not going to have to make those heartbreaking choices,” Obama said of families which had to deplete their resources in order to provide health care for uninsured children or loved ones.

Obama said there are 129 million Americans with pre-existing conditions who now will be able to obtain coverage, and that the ACA reflects the best intentions of the American people. “We aspire to protect one another from harm and exploitation,” he said.

The President took exception with critics he said characterize the ACA as a “budget-busting monstrosity.” He argued that “health care reform is part of deficit reform” and cited a Congressional Budget Office study that repealing ACA would “add a quarter of a trillion dollars to our deficit over the next decade and another trillion dollars to our deficit in the decade after that. They’re not just making this up.”

Obama touted examples of small businesses, he maintained, which are now, or would be soon, able to offer health insurance to employees by pooling together to negotiate rates similar to those garnered by larger companies.

Before he departed, Obama reminded attendees that he had visited the FamiliesUSA conference “four years ago this week” before even announcing his presidential bid, and had joined them in a promise “that we would make health reform a reality by the end of the next President’s first term. That is was we did; that is what you did,” he said to celebratory applause.

Yet, at least one attendee was still concerned about the potential of partisan politics to undermine the envisioned long-term success of health reform legislation. Though the Senate, still under Democratic control, has declined to take up the recently passed House legislation calling for repeal of the ACA, and, even though Senate passage of a similar bill would still face Obama’s presidential veto, Chaurice Corbin is wary. Corbin, who resides in Columbia, Md, and describes herself as an e-commerce entrepreneur, said Obama’s speech was “timely.” However, she observed, just like Obama “came out of the blue,” there is always a chance that another candidate could take the White House, particularly, in her opinion, if the economy has not yet recovered before the next election.

“President Obama,” Corbin said, “needs to marshal his lieutenants to come up with a game plan, a strategy, so in the event that he is not re-elected, health care will remain intact.”