Clinton backs ACA in speech, touts benefits

The Patient Protection and Affordable Care Act got a boost Wednesday from former President Bill Clinton, who praised the law's benefits and urged both its supporters and detractors to work together on fixing its problems.

Clinton's speech is a needed boost for the White House less than a month before open enrollment begins, especially as the Obama administration is now focused on garnering support from Congress for a military strike against the Syrian government. President Barack Obama has come under criticism since the 2010 passage of the law for not adequately explaining and promoting the law to counter the attacks against it. ACA supporters hope the man Obama called “the Secretary of Explaining Stuff” will help remedy that.

Addressing attendees at the Clinton Presidential Center in Little Rock, including Arkansas Gov. Mike Beebe, Clinton said he agreed to give the talk because he's “still amazed how much misunderstanding there is” about the current healthcare system, how it works and how it's going to change. Drawing from his experience as an attorney, Clinton mounted a case for the ACA. He noted that healthcare costs—which accounted for about 17.9% of the nation's GDP before Congress passed the law three years ago—contributed to 60% of personal bankruptcies in the U.S. before the economic crash. He also chided House Republicans for voting repeatedly to repeal or defund the statute while failing to offer what he called “real alternatives” to fix the system.

Sounding like an Obama administration official, Clinton ticked off some statistics that HHS has touted before, such as 3 million young adults under the age of 26 can now stay on their parents' healthcare plans; 17 million children with preexisting conditions can no longer be denied coverage; and 12 million people have received rebates from insurers because the law requires insurers to spend more of premium revenue on medical care and take less for overhead and profit.

“It's better than the current system, which is unaffordable and downright unhealthy,” Clinton said, adding that the law is the best chance the country has had for providing near-universal coverage, improving quality and lowering costs.

He acknowledged that the ACA has its share of problems and glitches, which is typical for any complex law. One issue he cited is that some American workers with modest incomes and job-based coverage aren't eligible to receive any subsidy to buy coverage for their family members through the state insurance exchanges. Under the law, Clinton explained, they're not able to send their family members into the exchanges. “It's bad policy,” he said.

Another problem that Clinton called a “whopper” was created when the U.S. Supreme Court's ruling last year made it optional for states to participate in the law's expansion of Medicaid to adults with incomes up to 138% of the federal poverty level. Clinton noted that big states with a lot of uninsured residents, such as Florida, Texas, Ohio and Pennsylvania, so far have rejected the expansion. He said that would result in a huge jump in uncompensated care at academic medical centers in cities such as Houston and Cleveland.

“Here's what will happen: Working people with incomes of between 138% and 400% of the federal poverty level will be able to buy insurance on the exchange through subsidies,” Clinton said. He noted that families in states that refuse to expand Medicaid who have incomes below 100% of the poverty “are eligible for nothing. So you get the worst of all worlds: You're working 40 hours a week, but you're too poor to get coverage. This is a serious problem.” (Individuals and families in states that refuse to expand Medicaid and have incomes between 100% and 138% of poverty can buy subsidized coverage in the state insurance exchanges.)

And the best way to address problems like that one and others in the law, Clinton urged, is head on.

“I hope the Congress will follow the lead of the example set by many, many Republicans and Democrats at the state level,” Clinton said, “and do the best they can to implement this law, be upfront and open about the problems that develop, and deal with them.”

Follow Jessica Zigmond on Twitter: @MHjzigmond