Obama meets a crossroads for his healthcare law

Obama meets a crossroads for his healthcare law
© Victoria Sarno Jordan

President Obama on Thursday will make a final pitch to the millions of Americans still lacking healthcare coverage as his administration enters its the fourth and final sign-up stretch. 

The president’s most immediate task in his Florida speech will be convincing the 23 million people in the U.S. still without coverage to sign up on HealthCare.gov starting on Nov. 1.


He’s also seeking to convince GOP lawmakers in Florida and 18 other states to embrace ObamaCare’s expansion of Medicaid. Thirty-two other states have accepted the Medicaid expansion.

But Obama’s highly anticipated speech in Miami will also serve a broader purpose – soothing the rising anxiety within his own party about the fate of the healthcare law. 

That tension has boiled over in the last month: First, former president Bill ClintonWilliam (Bill) Jefferson ClintonMcConnell proposes compressed schedule for impeachment trial Trump lawyers urge senators to swiftly acquit Trump in impeachment trial The American disease and death bowls MORE tore into the law, calling it “the craziest thing in the world,” followed by Minnesota’s Democratic Gov. Mark Dayton, who said it’s “no longer affordable.”

The new enrollment period has the potential to be the toughest one yet, with some insurers saying they need a larger share of younger, healthier people to sign up for ObamaCare. If those people don’t show up, the insurers say the could drop out of the marketplaces.

Weeks before a presidential election that would further cement his healthcare law, Obama has increasingly acknowledged its “real problems.” Many communities face shrinking competition among insurers, along with steep premium hikes.

Obama answered the calls of many progressives this summer by reaffirming his support for a government-run “public option” to compete alongside private options on the exchanges. 

He is likely to speak at length about the idea on Thursday, helping to draw support from progressives for Democratic presidential nominee Hillary ClintonHillary Diane Rodham ClintonDemocratic debates are magnet for lobbyists NYT editorial board endorses Warren, Klobuchar for Democratic nomination for president Sanders v. Warren is just for insiders MORE.

The proposal, once spearheaded by Sen. Bernie SandersBernie SandersSanders apologizes to Biden for supporter's op-ed Jayapal: 'We will end up with another Trump' if the US doesn't elect progressive Former health insurance executive: Current system is bankrupting country MORE (I-Vt.), has been widely embraced by Clinton, even as lobbyists from the pharmaceutical pressure hospital groups soundly reject the idea.

Obama could also weigh in on the many health policy proposals pitched by Clinton to bolster the law.

Those ideas include bigger subsidies, a stronger penalty for lacking insurance and a revamped risk strategy for health insurance companies – all of which would likely need Congressional approval to become law. 

As Obama mounts a defense of his law, he will near-certainly cast blame on the firewall of GOP opposition to any changes to the law. 

White House spokesman Josh Earnest acknowledged on Wednesday that the administration supports “some tweaks” to the law to improve it. He blamed the GOP for blocking those changes.

“It’s clear that Republicans in Congress don’t share the president’s interest in trying to improve health insurance in this country,” he said.

Supporters of ObamaCare have repeatedly blamed GOP leaders for some of the underlying problems with the law.

One example, they say, is the GOP’s largely successful efforts to block money from going to an insurance program called “risk corridors,” which has prompted some companies to duck out of the exchanges. 

Supporters say that program would have helped insurance companies fare better financially and reduce some of the hefty premium hikes this year that have prompted comments like those from Bill Clinton and Minnesota’s governor.

Dr. Zeke Emanuel, one of the architects of ObamaCare in 2009, said he blames the GOP for some of the law’s underlying problems.

He said Democrats who are criticizing the law publicly are coming from a place of “sympathy.”

“I think people are frustrated by the fact we can’t make changes,” Emanuel said. “Hopefuly once we’re past this election, we’re done with the ‘repeal and repeal’ rhetoric and we can we get on with, ‘Alrighty, what are we going to do to make this work?’

Some of the most powerful lobbyists involved with ObamaCare are also pressuring the next administration to make changes. 

Marilyn Tavenner, the head of America’s Health Insurance Plans, told a panel on Tuesday that one of the biggest issues involves “risk corridors” – the ObamaCare funding streams that was intended to protect insurers from higher-than-expected costs. 

Though it was intended to be three years, she said insurers need it extended because it is facing major shortfalls. 

“If the [marketplace] hasn’t stabilized in three years, we’re going to need some additional relief or extension of that,” she said of the risk corridors program. 

Some insurers have warned that they may need to exit the marketplace without more funding, and some already have.

Nearly one-fifth of people with ObamaCare are likely to only have one option for insurance on the exchanges next year, according to a study by the McKinsey Centers. Even supporters acknowledge that high-profile insurer exits, including by UnitedHealth and most recently Aetna, are proving that pieces of the law need to be revised.

The double-digit premium hikes across swaths of the country are fueling new attacks from the GOP, although the overall costs are still coming in under expectations.

Republicans such as Sen. Lamar AlexanderAndrew (Lamar) Lamar AlexanderMcConnell proposes compressed schedule for impeachment trial Juan Williams: Counting the votes to remove Trump Conservative groups aim to sink bipartisan fix to 'surprise' medical bills MORE (R-Tenn.) are increasingly warning about the “ObamaCare emergency.” One policy analyst for the conservative group Heritage Action for America said this week the law is experiencing “multi-organ failure.” 

As the law faces more scrutiny, both parties say it’s clear that more action is needed to deal with rising healthcare costs across the board, particularly prescription drugs. 

Bruce Josten, one of the chief lobbyists for the U.S. Chamber of Commerce, pointed out at a panel on Tuesday that the law’s scope was more limited than Democrats intended. 

He argued that the law wasn’t specifically designed to control costs and so it’s not surprising that it hasn’t addressed rising premiums and out-of-pocket costs. 

“Despite some early claims that the ACA was designed to reduce costs, it’s real objective was to reduce 45 million uninsured people in the country,” Josten said.