By Erin Mershon, CQ Roll Call
October 20, 2016 -- President Barack Obama gave an impassioned defense of his signature domestic achievement Thursday. He called forcefully for Republicans to abandon their efforts to repeal the 2010 health law and work with the next president to "smooth out the kinks."
In a wide-ranging speech that last nearly an hour, the president highlighted the popular improvements the health law had made for those with employer-sponsored insurance. He touted the historic reduction in the uninsured rate, too, in his remarks at Miami Dade College in Florida, where he will also join Democratic presidential candidate Hillary Clinton on the trail.
And he lambasted Republicans for repeated partisan attacks, and for failing to help fix the law -- even as he acknowledged again that the law has problems.
"Now is not the time to move backwards on health care reform, now is the time to move forward. The problems that may have arisen from the Affordable Care Act is not because government is too involved in the process. The problem is that we have not reached everybody and pulled them in," he said. "When one of these companies comes out with a new smartphone and it has a few bugs, what do they do? They fix it, they upgrade it. But you don't go back to using a rotary phone. You don't say, well, we're repealing smartphones. We're just going to do the dial-up thing. That's not what you do."
Obama's remarks come as the health law faces mounting challenges. Insurers are asking state and federal regulators to approve larger premium hikes than ever, some well past 50 percent, in an effort to cover higher-than-expected health costs. Major companies like UnitedHealth Group Inc. and Aetna Inc. have withdrawn from many of the marketplaces in which they had been participating, citing financial losses. Other insurers have gone bankrupt or been forced to shut down.
Obama didn't shy away from those criticisms. Instead, he placed some of the blame on state officials who have worked against enrollment efforts or opposed Medicaid expansion. He also attributed the premium increases to insurers underpricing their initial premiums.
"Just because a lot of the Republican criticism has proven to be false and politically motivated doesn't mean there aren't some legitimate concerns about how the law is working now," he said.
He emphasized repeatedly, however, that the premium increases making headlines would not affect the vast majority of Americans who get health insurance through their jobs or Medicare or Medicaid. About 3 percent of Americans are covered through marketplace plans.
And he pointed out that as premiums go up for individuals on the public exchanges, the tax credits most consumers receive will also go up, mitigating the costs.
Obama outlined four changes he would like to see to improve the law—all of which he has offered in recent weeks. He reiterated a call for the 19 states that have not yet expanded Medicaid to do so, quickly. He called for the next administration to use some of the cost savings associated with the law to finance an increase in the premium tax credits for individuals who don't currently qualify for them. And he urged states to innovate and develop their own approaches, a reference to 1332 waivers that permit states to avoid some health law requirements if they meet certain criteria, like providing coverage that is as comprehensive and affordable as under the law.
Obama also again voiced support for a fallback public option that would be triggered only if insurers aren't offering plans in certain areas. He noted the similarity of that approach to a provision in the Medicare Part D drug program that Republicans had championed.
"It was fine when it was their idea," he said. "That's not being consistent. It's being partisan."
In yesterday's press briefing, Press Secretary Josh Earnest said Obama supported such a public option "in all 50 states."
Republican Criticism
Obama speculated in his speech that things could change in 2017.
"Maybe now that I'm leaving office, Republicans can stop with the 60-something repeal votes they've taken and stop pretending they have a serious alternative," he said. "The next president and the next Congress should take what we've learned over the past six years and in a serious way analyze it to make the Affordable Care Act better. . . . We will need Republicans in Congress and in state governments to act responsibly and put politics aside."
Republicans, however, rapidly signaled they have little willingness to work on improving the law.
Speaker Paul D. Ryan, R-Wis., offered a scathing rebuke and called for Congress to pass his own alternative to the law.
"After listening to the president's speech, I'm not sure what health care law he's talking about," he said. "He wondered out loud why there's been such a fuss. It's no secret: It's because of Obamacare. ... And at this point, one thing is clear: This law can't be fixed."
Some Republicans started attacking the law before Obama even spoke Thursday.
"If the American people had a dime for every time the president offered another sales pitch for his disastrous health care law, they might actually be able to afford an Obamacare plan," said Rep. Tom Price, R-Ga., who chairs the Budget Committee, in a statement early Thursday.
Rep. Michael Burgess, R-Texas, went further in his critique, released hours before the remarks.
"Instead of acknowledging the problems in this law and working with Congress to remedy them, the Obama Administration continues to go to great lengths, sometimes illegally, to prop up the failing law in order to offer Americans unaffordable health care," he said in a statement.