It was more seminar than speech as President Clinton, a.k.a. Explainer in Chief, attempted to allay fears about the impending implementation of the Affordable Care Act, and to quell the insurrection looming in 21 Republican-led states that have opted out of parts or all of Obamacare. The former president said he agreed to give the talk because he is amazed at how much misinformation there is about how our system compares with others, and about the changes occurring now and in the future because of Obamacare.
Speaking from a podium Wednesday morning at the Clinton Presidential Center in Little Rock, Clinton held up a sheet of paper and said, “This is very unusual for me, I wrote the whole thing out.” The former president is known for speaking extemporaneously and ignoring a written text, but with the October 1 deadline fast approaching for people to begin signing up for coverage, Clinton wanted to make the best case he could.
Promising to use very few adjectives and a just-the-facts approach, he said, “I’m going to argue as best I can we’d all be better off working together … instead of keeping on replaying the same old battles.” The Obama administration is hoping Clinton can do for the controversial law what he did for the Obama campaign at last year’s Democratic Convention: deliver a key speech that frames the issue and gets everybody singing “Kumbaya.”
If there’s a silver bullet to sell the law to a skeptical public, it eluded Clinton. He did a good job debunking the current state of health-care delivery in the U.S., calling it “unaffordable and downright unhealthy,” but like everybody else who tries to simplify what Obamacare means, he got bogged down in too many statistics, at one point talking about competitive bidding for durable medical equipment (a good thing to hold down costs); a 40 percent decrease in bloodstream infections since 2008 (another good thing); and increased sterilization, “which is a high-toned way of saying you got to wash your hands more places in the hospital.”
Clinton knows way too much to keep it simple, but he tried valiantly, ticking off six reasons why lawmakers should work together (a theme he kept repeating) to implement Obamacare whether they supported it or opposed it. It’s better than what we have, the states have a role, the Medicaid money that states refuse will go somewhere else if they don’t accept it, and problems with the law—and there are some, he said—can best be solved if people work together. This is the best chance to achieve near-universal coverage and lower costs, “and finally it is the law,” he said, noting that obeying the law shouldn’t be optional. “To get one of these elected jobs, you take an oath to do that.”
“C’mon, Bill, there must be something wrong with this, it sounds too good to be true,” he said, poking fun at his cheerleading and launching into the next phase of his speech: the potential problems with Obamacare and what could still go wrong. He cited three: the first he hopes is “just a drafting error” that Congress can easily fix. Some workers with modest incomes are required to purchase coverage for their families but, due to a quirk in the law, don’t have access to the exchanges that offer affordable options. Second, Clinton said the tax credit for small businesses is too low. Third, which Clinton called “a whopper”: the right of states to refuse to take Medicaid money leaves lower-income families (those making up to 138 percent of a poverty-level income) stranded and “eligible for nothing,” Clinton said, “too poor to get help—not too rich, too poor,” even though they’re working 40 hours a week.
“Because of the Supreme Court decision, this is a problem only the states can fix,” Clinton said, noting that Republican governors in New Mexico, Ohio, and New Jersey are among those persuaded that the cost in uncompensated care for those left without coverage would far exceed any benefit from refusing federal money. The law allows the federal government to come in and set up and run exchanges to sell insurance in states that opt out, but Clinton said the law’s drafters “never dreamed anybody would turn down” a Medicaid expansion that has the feds paying 100 percent of the expanded cost for the first three years and upward of 90 percent after that.
Clinton stressed that reform makes economic sense, that the U.S. is “No. 1 by a country mile in how much we spend,” but No. 25 to No. 33 in outcomes. “You can’t make me believe we have to tolerate this until the end of eternity, not if we do this right,” he said. The U.S. spends 17.9 percent of GDP on health care compared with Japan, which spends 9 percent. The Netherlands and Switzerland are at 12 percent. The difference between 17.9 percent and 12 is $1 trillion a year, Clinton said, money that could go to pay raises or to investment to grow the economy or to more capital for small business.
“However old I am, I still remember what it was like to be 27,” Clinton said, a time of life when you think you will “live forever, never get a hangnail, much less a serious accident.” He urged young people older than 26, and no longer eligible to stay on their parents’ plan, to join the exchanges, noting in an aside that more young Republicans are enrolled in family plans than young Democrats, the only partisan jab in an otherwise broad-gauged appeal to the political class to come together and obey a law they may disagree with, as opposed to voting in vain for repeal, or worse, Clinton said, working to undermine the law and make its implementation a failure.