Obama: Perhaps We Can Change the Health Care Law Which We Assured You Would Not Be Changed


According to The Advisory Board's Dan Diamond, President Obama spent just 322 words on health care in his State of the Union last night, down from more than 600 last year—perhaps not surprising given the recent spike in the law's unpopularity. His message: He is open to changing the law, but not to gutting rules that require health insurers to cover those with preexisting conditions:

Not like this.

I have heard rumors that a few of you still have concerns about our new health care law. So let me be the first to say that anything can be improved.  If you have ideas about how to improve this law by making care better or more affordable, I am eager to work with you.  We can start right now by correcting a flaw in the legislation that has placed an unnecessary bookkeeping burden on small businesses.

The unnecessary bookkeeping burden Obama refers to is a provision that requires small businesses to file tax forms with any other business with which they conduct more than $600 in transactions. Getting rid of the provision is a good idea, although doing so will require legislators to come to some sort of agreement about if and how to pay for the estimated $17 billion in revenue that the provision was supposed to generate.

National Journal characterizes his approach to modifying the law as favoring a scalpel rather than a machete. But you can do a lot of damage with a few small cuts, especially in a law as complex as the Patient Protection and Affordable Care Act. In the coming months and years, there will be an array of interest groups and constituents lined up against specific provisions, all making the case that some specific provision must be changed. Already there are industry efforts under way to change or get rid of the Independent Medicare Advisory Board, the device tax, and a variety of other rules and requirements buried within the law. Obama, it seems, is signaling that, outside of the key insurance provisions, he may be willing to negotiate.

More like this.

Think about this in the context of what remains one of the stronger criticisms of the law: the Congressional Budget Office projected the law would likely reduce the deficit only it was executed exactly as written, which wasn't likely. If certain changes were made to the law by future Congresses—as CBO noted had happened with health laws designed to produce cost savings before—then those deficit savings would not materialize.

And now we have President Obama, not one year out from the law's passage, suggesting that he is willing to change one provision that was scored to bring in revenue, and is opening to ideas about changing other provision. We already know that his administration is willing to bend under pressure from businesses and unions: The 222 health law waivers handed out prove this. Even if you believe that those waivers are merely pragmatic concessions to doing what works, it is still suggestive of how the administration reacts to pressure to alter the law.

We also already know that Obama isn't willing to directly implement controversial cost-saving provisions if powerful interest groups object: The so-called "Cadillac tax"—an excise tax on expensive health insurance plans—is, according to the projections, going to be responsible for a great deal of the law's estimated savings. By taxing expensive plans, it will encourage many individuals to purchase less expensive insurance and thereby be more prudent with their use of care. But after union-led objections to the tax, the Cadillac tax provision was delayed until 2018—two years after Obama would finish a second term.

I don't mean to say that modifying the law would be a bad thing, or that the Obama administration should not be making exceptions to unduly burdensome regulations. On the contrary, like much of the country, I think the law is deeply flawed. If repeal is not possible, it should be changed. But the promise of deficit reduction was built on notion that the law would not be altered—an idea that has never been believable.

In its September and October 2009 scores of the PPACA, the CBO included some variation on the line that "these projections assume that the proposals are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation." That caveat was inserted into the scoring for a reason. Major legislation is rarely left unchanged. And as Obama reminded us last night, it's highly unlikely that this particular major legislation will prove an exception.

NEXT: We Can't Win the Future By Repeating the Past

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  1. I don’t mean to say that . . . the Obama administration should not be making exceptions to unduly burdensome regulations.

    Well, you should. These discretionary exceptions are an abomination in the eyes of the Rule of Law.

    If exceptions need to be made to the regulation, the regulation needs to be abolished.


      (wipes eyes)

      Rule of Law….and this has stopped this Leviathan before?

      Cadaverous Kathleen Sebelius needs to be gurneyed straight to a senate hearing stat and grilled hard (eww) over these waivers, not to mention her direct knowledge of this law thoroughly cross-examined.

      I would start with, “Sec. Sebelius, exactly how many times does the phrase ‘The Secretary shall determine,’ appear in this legislation?”

      Since we had to pass it to find out what’s in it, let her tell us. And if she can’t, demand her resignation on the spot.

      1. I look forward to seeing this on C-SPAN in the near future.

  2. I have heard rumors that a few of you still have concerns about our new health care law.”

    Did he really say that? That has to be a joke. What an arrogant fuck head. “I have heard rumors?

    1. He also hears the secrets that you keep… when you’re talking in your sleep.

      1. I can hear the things that you’re dreaming about, NutraSweet. You know, when you open up your heart and the truth comes out.

        1. Everything about you is a mystery.

          1. That’s what I like about you, NutraSweet. You keep me warm at night.

            1. I will always be your Tauntaun.

              1. The fat keeps me warm?

                1. And you thought he smelled bad on the outside?

                2. All that and so much more…Dominican?

    2. It was a joke. It was actually pretty funny. I mean, not as funny as his “I bowl like a retard” joke, but then again, what is?

      1. His speeches are so trite that you could just hear that coming out of his mouth. The joke is too damned close to reality to be funny.

        1. There was no open bar, and it’s the reason why comedy clubs have a two drink minimum. It was fine … I just wish people were drunk.

          1. You REALLY should take the pain pill.

    3. It really was in the speech. But intended as a joke.

  3. Obama, it seems, is signaling that, outside of the key insurance provisions, he may be willing to negotiate.

    Being willing to negotiate after you’ve already passed a sweeping and pervasive law is a bit like being willing to discuss birth control options after your mate is already pregnant.

  4. So let me be the first to say that anything can be improved.

    Since he was talking about his health care bill, he’ll need a time machine to be the first to say it could be improved.

    Now, if he actually has a time machine, I’ll give him a pass for all the extra government technology spending since his administration began.

  5. Democrats (the sole authors of and voters on PPACA) were never really interested in reducing the deficit by passing PPACA. The deficit issue was thrown into the mix to present another reason to vote for the monstrosity. Cover in the form of approving nods from the green eye shade crowd. So, from that perspective, it doesn’t really matter what effect any subsequent changes to PPACA has on the deficit, and I think you are seeing this in what Obama is saying.

    And while I’m here, I’ll state that the whole notion that “Americans are spending too much on health care” – a notion that also was thrown into the mix as a reason to “do something” – is really missing the point. Sure, all else being equal, everyone wants what they are buying to be less expensive. And libertarians understand how to make things less expensive over time (hint: it has nothing to do with what you find in PPACA). But it’s quite possible that, given the advances in medical science, people will want to spend a greater and greater fraction of their wealth on medicine in contrast to other wants and needs. There is nothing wrong about spending more as a nation on medicine per se. We spend more on internet connectivity now than we did in 1975. Is that a bad thing?

    1. The point here Draco is that the American public have been so divorced form the true cost of health care, i.e. employer sponsored policies, coupled with the notion that health care is a “right” (read: the right to pick the pockets of my neighbor with a government bully looking on) that what the public will not, and I repeat will never accept a lowered standard of material living i.e. giving up niceties and so-called “needs” in lieu of paying for their own health care.

      What the majority of the American population wants is to enjoy their current standard of living AND their health care.

      The proof? Two things: the staunch refusal to admit that employer sponsored policies are indeed a form of income and should be subject to taxation as opposed to employers footing the tax and that wanting pre-existing conditions covered is not insurance but truly a subsidy, AKA welfare.

      How many people would give up their iPads, stylish clothes, trips eating out, and every other keeping-up-with- the-Joneses activities if it meant paying for their own policies?

  6. Not sure if I totally agree with the title of this article. When this bill became law, didn’t Obama try to appeal to his single-payer plan supporters by comparing it to Soc Sec and Medicare, in that it was just a starting point to be expanded upon?

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