President Barack Obama described the Affordable Care Act as part of the fabric of middle-class economic recovery as he delivered a State of the Union address to a Republican-controlled Congress intent on dismantling the law.
Obama defended the Patient Protection and Affordable Care Act, pointing out that roughly 10 million Americans have gained coverage under its provisions and that the level of uninsured has dropped significantly since full implementation of the law.
"We can't put the security of families at risk by taking away their health insurance, or unraveling the new rules on Wall Street, or refighting past battles on immigration when we've got a system to fix," Obama said, speaking before a packed audience in the House chamber at the Capitol. "And if a bill comes to my desk that tries to do any of these things, it will earn my veto."
Obama laid out his priorities for the final two years of his administration, focusing primarily on spreading the economic recovery to the lower and middle classes. But unlike past State of the Union addresses, healthcare was not a focal point.
For the first time in his presidency, Obama faces a Congress fully controlled by Republicans. The debate on Capitol Hill, including on healthcare policy, will become increasingly entangled in presidential politics as jockeying begins for the 2016 contest.
Republicans continue to cite repealing Obamacare as among their top priorities. But there is widespread acknowledgment that doing so will be impossible with Obama still in office and wielding a veto pen.
Instead, Republicans will seek to knock out key pieces of the ACA, as Sen. Orrin Hatch (R-Utah), the new chair of the Senate Finance Committee, explained in a speech before the U.S. Chamber of Commerce on Tuesday. Among the top targets of congressional Republicans: the medical device tax and the mandate for employers to offer health insurance.
But hanging over the healthcare policy debate in Washington will be the King v. Burwell case before the U.S. Supreme Court challenging insurance subsidies in states that haven't created their own exchanges. If the court rules in favor of the plaintiffs, it could result in 9.3 million low-and-middle-income Americans losing access to subsidies (PDF) worth $28.8 billion in 2016, according to an analysis by the Urban Institute.
Obama hailed the efforts of U.S. healthcare workers in helping to halt the spread of the Ebola virus in West Africa. More than 8,000 people have died from the outbreak, but new infections have been reduced to a trickle in recent weeks. "The job is not yet done, and the world needs to use this lesson to build a more effective global effort to prevent the spread of future pandemics, invest in smart development and eradicate extreme poverty," Obama said.
Obama also proposed a new program dubbed the Precision Medicine Initiative to fight diseases such as cancer and diabetes, although he offered few specifics. "I want the country that eliminated polio and mapped the human genome to deliver a new era of medicine, one that delivers the right treatment at the right time," Obama said.
Obama also vowed to fix problems with healthcare delivery at the Veterans Health Administration, which has been marred by dysfunction, including waiting periods for treatment that routinely exceed guidelines. "Already, we've made strides towards ensuring that every veteran has access to the highest quality care," Obama said.
Freshman Sen. Joni Ernst (R-Iowa) gave the GOP rebuttal to the president's address. During the primary campaign season, Ernst ran an ad featuring footage of her at a gun range vowing to take aim at Obamacare.
"We see the hurt caused by canceled healthcare plans and higher monthly insurance bills," Ernst said on Tuesday. "We see too many moms and dads put their own dreams on hold while growing more fearful about the kind of future they'll be able to leave to their children."
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