By Melissa Attias, CQ Roll Call
September 4, 2013 -- Former President Bill Clinton in a recent speech urged those on both sides of the 2010 health care law to overcome their divide and implement and improve the overhaul, while pointing to three key problems that he thinks should be fixed.
Clinton cited the affordability of health insurance for workers' dependents, the small business tax credit and a gap in Medicaid coverage as items that should be improved. While his remarks were blended with praise for the law and a plea for unity, they also represented an acknowledgment from a senior Democrat that the overhaul could be made better.
Clinton's remarks, delivered at the Clinton Presidential Center in Little Rock, Ark., and carried by the White House blog, came less than a month before the health insurance exchanges are slated to begin open enrollment. While Republicans have continued their efforts to repeal and dismantle the overhaul (PL 111-148, PL 111-152), Clinton pushed for an "all hands on deck" approach to implementation.
"It seems to me that the benefits of reform can't be fully realized and the problems certainly can't be solved unless both the supporters and the opponents of the original legislation work together to implement it and address the issues that arise whenever you change a system this complex," he said. "We're going to do better working together and learning together than we will trying over and over again to repeal the law or rooting for reform to fail and refusing to fix relatively simple matters."
But Chris Jacobs of The Heritage Foundation contested several aspects of Clinton's speech in a blog post, including the former president's message about working together to repair the overhaul. Jacobs questioned why conservatives should move on from their efforts to repeal the health care law, which they believe is harmful, if President Barack Obama is continuing to press for a repeal of the budget sequester because of its perceived harm.
"The answer is simple," Jacobs wrote. "Liberals didn't abandon their belief in a government-centric scheme for health care after President Clinton's failed effort in the 1990s. Likewise, conservatives should not now abandon their belief—based on all the implementation failures to date—that Obamacare won't deliver for the American people. It is so unworkable that it should be defunded and repealed."
Clinton touted Obama's signature law and explained its benefits in detail, but he also acknowledged that there are some problems with the measure that need to be addressed. He said his greatest worry is whether the families of workers with modest incomes face barriers to obtaining coverage.
His comments appeared to line up with some groups' concerns that families will not be able to access affordable coverage through a worker's plan or receive subsidized coverage through the exchanges under a final Treasury Department rule released in January.
"It's obviously not fair and it's bad policy, but it's not clear to me based on what I can determine that anybody intended this," Clinton said. "I think Congress should fix it."
Clinton also said he believes the current tax credit for small businesses to provide their employees with insurance is too low. While he noted that a 50 percent tax credit sounds like a lot, he argued that "if you read the fine print and how it's calculated, there are relatively few companies eligible for the 50 percent tax credit." As the average wage increases, he said, the tax credit decreases to below 50 percent.
Clinton said he wants Congress to make the tax credit "available to more firms for more employees under the 50-employee limit and actually make it more generous to more firms so more will show up."
A third issue Clinton pointed to, which he called "a whopper," stems from the Supreme Court's ruling that states can opt out of the law's Medicaid expansion without putting the rest of their federal Medicaid funding at risk. Clinton argued that Congress never dreamed states would turn down the Medicaid money, but since the ruling about half the states have.
In those states, Clinton said individuals with incomes between 138 percent and 400 percent of the poverty line will be eligible for subsidies on the exchanges. But those with incomes at or below 138 percent of the poverty line are not eligible for anything, he said.
"So you get the worst of all worlds, where you say, 'I'm sorry but you're too—you're working 40 hours a week but you're too poor to get help.' Not too rich, too poor. And this is a serious problem," Clinton said.
"Because of the Supreme Court decision, this is a problem that only the states can fix," he added.
In addition, Clinton used the speech to rebut two other persistent questions about the law —whether enough young, healthy people will enroll in coverage and whether requirements related to the number of employees and full-time hours will cause a shift to part-time work. He also said many people are worried about computer issues, but that he's been impressed with what he's seen so far.
"Now there may be glitches, but so far there's no evidence to suggest that they won't be able to be fixed quickly," he said.
Clinton said he agreed to give the speech because of the level of "misunderstanding" about the current health care system and changes required under the law. He said that studies show that the United States ranks first in the percent of income spent on health care costs but ranks only 25th to 33rd in outcomes.
"The health of our people, the security and stability of our families and the strength of our economy are all riding on getting health care reform right and doing it well," Clinton concluded. "That means we have to do it together."