WASHINGTON ― A fiery President Barack Obama visited Miami Thursday to deliver a speech promoting the upcoming health insurance enrollment period, and he used the occasion to settle some scores with Republicans who have opposed his health care reform efforts at every turn.
At times, Obama sound frustrated and rueful that the Affordable Care Act, his signature domestic policy achievement, remains unpopular, poorly understood and the object of unending partisan fighting. He touted its successes in bringing the uninsured rate down to a historic low and guaranteeing coverage to people regardless of pre-existing conditions. He also acknowledged some consumers still face unaffordable insurance costs and offered some remedies for the law’s shortcomings.
The president, sometimes while bitterly laughing, pulled no punches when it came to portraying Republicans at the federal and state level as obstructionists who put their opposition to “Obamacare” ahead of serving their constituents.
“Why is there still such a fuss? Well, part of the problem is the fact that a Democratic president named Barack Obama passed the law,” he said.
“Now that I’m leaving office, maybe Republicans can stop with the 60-something repeal votes they’ve taken and stop pretending that they have a serious alternative and stop pretending that all the terrible things they said would happen have actually happened when they have not, and just work with the next president to smooth out the kinks,” he said.
“They can even change the name of the law to Reagancare or they can call it Paul Ryan-care. I don’t care,” Obama said.
Obama spoke at Miami Dade College; later Thursday, he was scheduled to attend a Clinton campaign rally and an event for the Democratic Governors Association.
The president repeatedly referenced the Affordable Care Act’s heritage as a conservative policy ― including the 2006 Massachusetts law enacted by then-Gov. Mitt Romney (R) ― and upbraided the GOP for the party’s single-mindedness about repealing the ACA, its portrayal of the law as a threat to American society and its failure to propose a workable alternative since this debate began in 2009.
“Early on, Republicans just decided to oppose it, and then they tried to scare people with all kinds of predictions,” Obama said, citing claims that law would destroy the job market, completely take over the health care system, ration medical care and establish “death panels” to deny treatments to the sick. Obama also faulted Republicans in state governments for impeding the law’s implementation or, at least, not facilitating enrollment of uninsured people.
“They just can’t admit that a lot of good things have happened and the bad things they predicted didn’t happen,” Obama said “So they just keep on repeating, ‘We’re going to repeal it. We’re going to repeal it and replace it something better,’ even though six and a half years later, they still haven’t shown us what it is that they would do that would be better.”
The three-month open enrollment period on HealthCare.gov and the state-run health insurance exchange marketplaces begins Nov. 1, and the effort faces significant headwinds. Premium increases for next year are considerably higher than during the first three years of exchange sign-ups, and health insurers quitting some marketplaces has significantly diminished competition, especially in states where only one insurance provider is participating in the exchanges.
On Wednesday, the Department of Health and Human Services announced it expects enrollment to grow by just 1.1 million people between 2016 and 2017, reaching a total of 13.8 million.
Obama conceded ― as he has before ― that despite the successes of the ACA, affordability and lack of insurance remains a problem for a segment of the population. “There are going to be people who are hurt by premium increases or a lack of competition and choice. And I don’t want to see anybody left out without health insurance,” he said.
Obama has proposed numerous amendments to the law, as he recently laid out in an article in the Journal of the American Medical Association, but the GOP-led Congress has not considered them, instead remaining fixated on repeal and their own vague plans to remake the health care system. Republican presidential nominee Donald Trump has been even less clear about his health care agenda.
“We’re open to good ideas but they’ve got to be real ideas, not just slogans, not just votes to repeal. They’ve got to pass basic muster,” Obama said. “You can’t say, ‘Well, if we just plant some magic beans, then everybody will have health insurance.’”
As if to burnish Obama’s argument about GOP aversion to meeting the health care market where it currently is, House Speaker Paul Ryan (R-Wis.) issued a statement shortly after the president’s speech reaffirming his party’s disinterest in working to improve the health care system as remade by the Affordable Care Act and completely ignoring the ACA’s accomplishments.
“One thing is clear: This law can’t be fixed,” Ryan’s press release said. “That’s why we need to repeal Obamacare and replace it with patient-centered reforms.”
During his remarks, Obama touted three broad proposals to improve the ACA and make health insurance more affordable ― policies that are consistent with Democratic presidential nominee Hillary Clinton’s campaign platform.
First is for the 19 states that have refused to take up Obamacare’s Medicaid expansion to do so, in the process covering millions more poor adults. Second is to beef up the subsidies provided to people who get their coverage from the law’s health insurance exchanges. And third is to set up a government-run public option program ― which Obama called a “public plan fallback” ― in geographic areas with the highest prices and least competition.
Obama stressed that more than 80 percent of Americans don’t get their health insurance from the exchanges, but instead from employers or government programs like Medicaid and Medicare, and thus aren’t affected by the rate hikes in the marketplaces. He also noted that the majority of exchange consumers receive tax credit subsidies that will shield them from price increases. But he lamented that there remain people who have been left behind by the coverage expansion or who can’t afford the coverage currently available.
“Just because a lot of the Republican criticism has proven to be false and politically motivated doesn’t mean that there aren’t some legitimate concerns about how the law is working now,” Obama said. “And the main issue has to do with the folks who still aren’t getting enough help.”