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Obama Plays It Safe on the State of Health Care

By Dena Bunis, CQ HealthBeat Managing Editor

January 26, 2011 -- When it came to health care, President Obama's remarks in the House chamber were predictable and safe.

He told his base that he would continue to defend against any attempts to beat back the health overhaul law, his signature domestic achievement. And he continued to throw familiar bones to Republicans: that he's behind fixing the 1099 tax-reporting requirement and willing to talk about changes to medical malpractice laws.

Obama segued from the section in the speech about reducing barriers to growth and investment to the short passage on health care with a dig at the insurance companies. "It's why we passed reform that finally prevents the health insurance industry from exploiting patients.

"Now, I've heard rumors that a few of you have some concerns about the new health care law,'' Obama said, without mentioning the R word. Instead of talking repeal he used two people in first lady Michelle Obama's box to make his point about why he wouldn't entertain a rollback of the law.

"What I'm not willing to do is go back to the days when insurance companies could deny someone coverage because of a preexisting condition,'' Obama said. "I'm not willing to tell James Howard, a brain cancer patient from Texas, that his treatment might not be covered. I'm not willing to tell Jim Houser, a small-business owner from Oregon, that he has to go back to paying $5,000 more to cover his employees ... So instead of refighting the battles of the last two years, let's fix what needs fixing and move forward." The checkerboard seating arrangement of Republicans and Democrats was clear after that line as virtually every other lawmaker—Democrats—applauded.

"It is not surprising, but always reassuring, that the president reaffirms his conviction that we should build on, rather than destroy, the huge advances made by the Affordable Care Act,'' said Ron Pollack, head of Families USA, which has been battling for an overhaul bill for many years. Pollack said he believes Obama will expand on his State of the Union address when he talks to Families USA's Washington meeting on Jan. 28.

Longtime Washington hands agreed that the president played it safe.

"The law is contentious with the new House members, many of whom were elected in part because they said they would repeal the law,'' said Dan Mendelson, president of the Washington consulting firm, Avalare Health. "Dwelling on the Affordable Care Act would not have been perceived as a conciliatory bipartisan posture, which is what he struck in the speech overall."

Even though Obama gave no specifics about what he would be willing to accept when it came to revamping medical malpractice laws, America's trial lawyers did not like what they heard.

"As many as 98,000 people die every year from preventable medical errors, with countless more injured,'' American Association for Justice (AAJ) President Gibson Vance said in a statement. "President Obama should direct his focus towards tackling this startling figure, not promoting efforts that could eliminate the legal rights of patients." AAJ is the nation's largest trial bar group.

Also predictable was the portion of House Budget Chairman Paul D. Ryan's Republican response that dealt with health care.

"What we already know about the president's health care law is this: Costs are going up, premiums are rising, and millions of people will lose the coverage they currently have," Ryan, of Wisconsin, said in his prepared remarks. "Job creation is being stifled by all of its taxes, penalties, mandates and fees. Businesses and unions from around the country are asking the Obama administration for waivers from the mandates. The President mentioned the need for regulatory reform to ease the burden on American businesses. We agree—and we think his health care law would be a great place to start."

Pollack pushed back on the GOP message after reading Ryan's comments.

"It is beyond absurd that he talks about people losing health coverage due to the Affordable Care Act,'' Pollack said in an e-mail. "The House Republicans' repeal proposal would result in 32 million people unnecessarily remaining without health coverage."

Grace-Marie Turner, president of the conservative Galen Institute, said that Obama "had to acknowledge that his health plan is not popular after the House voted to repeal it. But he still sounds very stubborn in saying that he will only work with them to make coverage better and more affordable. Why didn't he do that in the first place? Of all the things the president talked about in his speech, health care is the thing they are going to have the hardest time finding common ground about. The Republicans have a very different vision of how you get to a more affordable, patient-centered system, and they can't build their plan on top of the infrastructure of the president's law that relies on government and central planning."

Ryan delivered his remarks from the Budget Committee hearing room. "Last week, House Republicans voted for a full repeal of this law, as we pledged to do, and we will work to replace it with fiscally responsible, patient-centered reforms that actually reduce costs and expand coverage,'' he said.

House committees already have begun that work. Last week the Judiciary Committee held a hearing on medical malpractice. Ryan's committee holds a hearing on the fiscal impact of the law and the Ways and Means Committee has a hearing on its the economic and regulatory impact.

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