Obama Makes Only Modest Mention Of Health Care In State Of Union

KHN’s Mary Agnes Carey talks with Jackie Judd about President Obama’s State of the Union speech. Obama talked little about health care, reflecting maybe the hard sell they’re having getting the public to buy into the health law’s benefits. Republicans talked about reforming Medicare in their response.

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JACKIE JUDD: Good day, This is Health on the Hill. I’m Jackie Judd. President Obama delivered his State of the Union message last night and made only a modest mention of the issue that helped define the first half of his administration: health care reform.

PRESIDENT BARACK OBAMA (video clip): I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny your coverage, or charge women differently than men.

JACKIE JUDD: Here to discuss the State of the Union and the Republican response is Kaiser Health News reporter Mary Agnes Carey. Welcome, as always.

MARY AGNES CAREY: Thank you.

JACKIE JUDD: I took a look at earlier State of the Union speeches, and back in 2010 the president devoted about 7 paragraphs to the issue of health care reform. A couple last year. What was the administration’s calculation to give it such small play?

MARY AGNES CAREY: Basically, everyone knew this was going to be a speech about the economy and that certainly was a speech about how to repair the economy, how to get it back on track, how to create more jobs. But the minimal mention of the health law may be a reflection of the difficulty that the president, the administration, supporters of the health law are having selling it to the public.

For example, the latest Kaiser Family Foundation tracking poll found that just 41 percent of Americans have favorable views of the law; 43 percent have unfavorable views. The individual mandate – the requirement that most Americans by 2014 have to purchase insurance or pay a fine, that’s the issue before the Supreme Court right now – that is wildly unpopular with the public. (note: KHN is an editorially-independent program of the foundation.)

So the president focused on the provisions that are popular. For example, talking about insurers will no longer have unchecked power to cancel your coverage; they can’t charge women more. In a counterpunch to Republican attacks against the health law, President Obama talked about how the health law relies on a reformed private market. It’s not a government program.

JACKIE JUDD: As many analysts said last night, this was as much a State of the Union as it was a campaign speech. So, it was a hint as to how the president will address this issue on the campaign trail.

MARY ANGES CAREY: I think he’ll talk about it. He’ll talk about again the issues that are popular with folks. But he has to maneuver around the fact that a lot of Americans are wrestling with the health law: “What’s in it for me? What matters for me?” And a lot the big provisions don’t even kick in until 2014.

JACKIE JUDD: And last night in his speech, he made brief mention that he’s prepared to make reforms to rein in Medicare and Medicaid spending. And that’s what Indiana Gov. Mitch Daniels zeroed in on in the Republican response. Take a listen.

GOV. MITCH DANIELS (video clip): We must unite to save the safety net. Medicare and Social Security have served us well, and that must continue. But after half and three-quarters of a century, respectively, it’s not surprising they need some repairs. We can preserve them unchanged and untouched for those now in or near retirement, but we must fashion a new, affordable safety net so future Americans are protected, too.

JACKIE JUDD: So, in a way, the Republicans made a more sustained statement on health care than the president did. The same question I asked you earlier: What was the GOP calculation?

MARY ANGES CAREY: Well, they evidently have a great comfort level now talking about Medicare, talking about Medicaid and the safety net. Mitch Daniels mentioned the safety net six times. He talked about how we can’t afford to give Medicare benefits to millionaires anymore: this whole issue of income-relating that has come in and out of the discussion.

I think that Republicans intend to – they’re trying to cast themselves as protectors of Medicare and Medicaid. Of course, the views they have vs. Democrats and the president are extremely different. But I think it shows a comfort level that they would hit this so hard in their response and have such a sustained discussion.

JACKIE JUDD: Change of course, but sticking on the issue of Medicare. Yesterday, just before the State of the Union, House and Senate conferees got together for the first time to discuss the payroll tax extension, the cut, and part of that of course is the “doc fix.” What should doctors who treat Medicare patients be reimbursed? Any progress in those conversations?

MARY AGNES CAREY: This was about an hour and a half of opening statements, but it became clear that both Republicans and Democrats on the conference committee do not want Medicare physicians to face a 27 percent payment cut at the end of February, which is when the current fix expires. The difference of course, as always, is on how do you pay for it? Several Democrats talked about using the war savings to pay perhaps for a long-term fix for the sustainable growth rate. Republicans aren’t really crazy about that. Dave Camp, who heads the conference, head of the Ways and Means Committee, said using war savings for the SGR is not on his top 10 list. But everyone seems committed to fixing it. The question is how do you finance it.

JACKIE JUDD: OK, thank you so much, Mary Agnes Carey, Kaiser Health News.

MARY AGNES CAREY: Thank you.