Did Health Care Speech Accomplish Obama's Goals?

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President Obama has laid out more specifics than he has before about what he wants in a health overhaul bill. He tried to explain to the public what a reconfigured health system might look like. And he called out those who he said were using scare-tactics to score short-term political points.

STEVE INSKEEP, host:

Now let's take a closer look at what the president proposed.

NPR's Julie Rovner has been covering the story for years and was listening last night. She has been helping us all this year - keep our fact straight. Good morning, Julie.

JULIE ROVNER: Good morning, Steve.

INSKEEP: What changed last night, if anything?

ROVNER: Well, you know, until now, we've been talking about the president's planned this - the president's planned that. But, there really wasn't a president's plan. There were all of these plans floating around on Capitol Hill. There rather purposely wasn't a president's plan. President Obama had left all the details to Congress. He had given them sort of a page of guidelines. And this, I think, was an effort for there to become a president's plan. Now, what he laid out was similar to what a lot of the Democrats in Congress have been doing, but not identical. I think there was also a big shift in emphasis. Until now, there had been a lot of talk about really how to help people who didn't have insurance and not too much on really looking at those people - the 160 - 180 million people who have insurance - really what's in it for me? So, let's listen.

(Soundbite of applause)

President BARACK OBAMA: They'll no longer be able to play some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime.

(Soundbite of applause)

Pres. OBAMA: We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America no one should go broke because they get sick.

(Soundbite of applause)

ROVNER: So, changes in the rules for insurance. That what's on offer for those with insurance - what about those without insurance?

ROVNER: Well, very much like most of the plans that are floating around in Congress, the president is promoting something called health insurance exchanges. These are marketplaces where individuals and small businesses could go to buy insurance. Here's how the president explained it last night.

Pres. OBAMA: If you lose your job or you change your job, you'll be able to get coverage. If you strike out on your own and start a small business, you'll be able to get coverage. We'll do this by creating a new insurance exchange, a marketplace where individuals and small businesses will be able to shop for health insurance at competitive price.

ROVNER: And for individuals and small businesses who can't afford the cost, there will subsidies and tax credits. And that's, of course, what accounts for most of this bill's big price tag.

INSKEEP: Hundreds of billions of dollars over a decade.

ROVNER: Indeed.

INSKEEP: And we should note that under the president's plan, as laid out last night, if you don't have insurance right now, you're going to be required to get it.

ROVNER: Yes. In most cases, there are some hardship exemptions. That's a flip-flop from his primary campaign. He was actually the only Democrat who did not endorse that. But that's what they do in Massachusetts, so that's a big piece of this.

INSKEEP: Massachusetts, one of the states that's got something like universal health coverage or something close to that. Why would the president change on that?

ROVNER: Well, in fact, it was made finally clear to him that the system really doesn't work unless everyone is in it. It's really the only way to cover everyone, is if everybody has insurance. It's what they called shared responsibility.

INSKEEP: Julie Rovner, the president said he was embracing some Republican ideas; try to take this very partisan issue right now and try to position himself as being bipartisan. Is he embracing Republican ideas?

ROVNER: A few. He did make sort of a nod in the direction of doing something about medical malpractice lawsuits and defensive(ph) medicine, endorsing some demonstration projects. There were a couple of Republicans that said that's a nice thing.

He didn't go very far in that direction. He talked about Senator John McCain's idea to have high-risk pools for people who couldn't get insurance, that that might be an interim step while they're waiting for these preexisting condition exclusions to come into effect four years from now if this were to become law.

INSKEEP: So, a little bit there; not too much. The president actually got booed at one point, by Republicans, when he said that illegal immigrants would not be covered under his plan. Let's listen:

Pres. OBAMA: There are also those who claim that our reform efforts would insure illegal immigrants. This too is false.

(Soundbite of booing)

Pres. OBAMA: The reforms I'm proposing would not apply to those who are here illegally.

Representative JOE WILSON (Republican, South Carolina): You lie.

(Soundbite of booing)

INSKEEP: Now, in the middle of that booing, you can hear Representative Joe Wilson of South Carolina shout out, you lie. There's been a lot of the coverage of the etiquette of this. Wilson has apologized, but let's ask about the substance. Was the president truthful in saying that his plan is not going to cover illegal immigrants?

ROVNER: Yes. The president was truthful in saying the plan does not give benefits to illegal immigrants. The Republicans are complaining that there are loopholes in the plan that would let illegal immigrants get benefits anyway. This is because the Democrats have rescinded some rules that were so onerous that it was preventing citizens from actually getting benefits.

INSKEEP: And just very briefly, in a few seconds, is it clear now, that the president is going to be able to extend coverage to millions of people - which costs a lot of money - and still save money on a health care system that he says is spending too much money?

ROVNER: That's the hard part. Congress is still working on it. It's going to take several more months to see if that could be figured out.

INSKEEP: Julie, thanks very much.

ROVNER: You're very welcome.

INSKEEP: NPR's Julie Rovner in our studios in our morning.

(Soundbite of music)

INSKEEP: It's MORNING EDITION from NPR News.

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Obama's Plea: 'Deliver On Health Care'

WIDE 4: President Obama is greeted on Capitol Hill after delivering his address to Congress i

President Obama is greeted on Capitol Hill after delivering his address to a joint session of Congress Wednesday night. Susan Walsh/AP hide caption

itoggle caption Susan Walsh/AP
WIDE 4: President Obama is greeted on Capitol Hill after delivering his address to Congress

President Obama is greeted on Capitol Hill after delivering his address to a joint session of Congress Wednesday night.

Susan Walsh/AP
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President Obama used the power of his bully pulpit Wednesday night to take on critics of his beleaguered health care plan, decrying scare tactics used by opponents and pushing again for a non-profit public insurance option.

"The time for bickering is over," Obama said to sustained applause before a joint session of Congress. "The time for games has passed."

In his prime-time address, the president offered few new details but made a fresh and newly fervent case for his signature domestic policy issue. After weeks of leaving the bitter wrangling over his health care initiative to Congress and watching his approval ratings slide — Obama stepped directly into the fray. He appealed to the nation's middle class, and promised nervous Americans who like their insurance that proposed changes to the nation's health care system would not affect their coverage.

"I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice," Obama said. "And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care you need."

Obama made a forceful argument for the need for a health care fix, citing the system's high and rising costs, the waves of people losing coverage and the burden individuals and companies bear in higher premiums and co-pays. And, responding directly to criticism that his $900 billion-over-10-years plan would send deficits skyrocketing, he pledged that he would not sign a plan that "adds one dime to our deficits."

"Now is the season for action," said Obama, who later invoked the memory of the late Sen. Edward Kennedy, the longtime Massachusetts Democrat who called the goal of health insurance for all his life's work. Kennedy's widow, Victoria Kennedy, sat in the chamber with First Lady Michelle Obama.

Goodbye To Bipartisanship?

Obama's speech was intended to spur action on an issue that, in recent weeks, has become mired in partisan politics. The president took on assertions about his plan — since debunked — that have stalked overhaul deliberations.

Obama called the tumultuous summer, during which a growing number of people questioned his ability to handle the health care issue, "a partisan spectacle" fueled by "bogus claims spread by those whose only agenda is to kill reform at any cost."

He characterized as a "lie, plain and simple" claims that there are plans to set up "panels of bureaucrats with the power to kill off senior citizens." Also false, he said, are claims that federal money would be used to fund abortions and that illegal immigrants would be insured.

The statement on illegal immigrants triggered a shout of "You lie!" from Rep. Joe Wilson, R-S.C. Wilson later apologized for the outburst, releasing a statement saying that he "let my emotions get the best of me."

Obama also scolded Republicans who have tried to scare senior citizens into thinking coverage would be taken away. Such claims, the president said, distorted his proposal to wring savings out of the nation's Medicare and Medicaid systems by identifying fraud and waste.

"Don't pay attention to those scary stores about how your benefits will be cut," he said. "Especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past."

But Obama also offered Republicans an olive branch, announcing that his administration will explore ways to address medical malpractice costs — a pet GOP issue.

Although the door to a bipartisan bill is still open, Obama made it clear that he has limits.

"I will continue to seek common ground in the weeks ahead," he said. "But know this: I will not waste time with those who have made the calculation that it's better to kill this plan than improve it."

Public Option Lives — For Now

Obama made his case for a public insurance option, arguing that it would provide needed competition in states like Alabama — where, he said, almost 90 percent of the insurance market is controlled by one company. In 34 states, Obama said, 75 percent of the marked is controlled by five or fewer companies.

"Without competition, the price of insurance goes up, and the quality goes down," he said, leading companies to "cherry-pick" healthy individuals to cover.

"I have no interest in putting insurance companies out of business," he said. "I just want to hold them accountable."

Answering claims that a public option, available to those without insurance, would be tantamount to a government takeover, Obama said that its effect "shouldn't be exaggerated — by the left, the right or the media." He says that less than 5 percent of Americans would sign up for it, and that it is just one part of his plan.

But he also had words of caution for "progressive friends" who have made the inclusion of a public option a make-or-break point for their support.

"I would remind you," he said, "that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it."

"The public option is only a means to that end — and we should remain open to other ideas that accomplish our ultimate goal."

Going It Alone, If Necessary

Obama's speech came hours after Senate Finance Committee Chairman Max Baucus, a Montana Democrat who for months has been working on a bipartisan compromise, said that that his committee will start voting on a health care bill in coming weeks — with or without GOP support.

Baucus, leader of his committee's so-called bipartisan Gang of Six, has produced his own compromise plan and had hoped — but failed — to get the gang to sign on before Obama's speech.

But Baucus also made a prediction about the "public option" — long a sticking point in negotiations among some Democrats.

"I think— quite frankly, with increasing conviction — that a public option cannot pass the Senate," he said. Conversely, liberal Democrats in the House including Speaker Nancy Pelosi have said that a bill without a public option is not viable; conservative House Democrats have opposed the public option.

Republicans, who have yet to offer a health care plan, have argued that they have been seeking middle ground that would slow down the overhaul and reduce its cost. Their assertions, however, have been undermined in recent days by party leaders including GOP Chairman Michael Steele and House Minority Leader John Boehner — who have said they would oppose any plan put forth by the president, with or without the controversial public option.

The public option, Boehner said Wednesday, "is not the only bitter pill in the plan."

Movement In The Senate

With Republicans recently gaining a political toehold by running hard against a health care remake, the pledge by Baucus to go it alone if necessary could bolster Obama's message. Baucus said Wednesday that the "time has come for action, and we will act," words echoed later that day by the president.

The Baucus proposal, which would likely go to the full committee for consideration the week after next, would probably be "fairly close" to a compromise health care plan he floated over the weekend, Democrats said.

Baucus' $880 billion compromise framework does not call for a public insurance option to compete with private insurers. It instead advocates member-run insurance cooperatives as an alternative way to meet the president's desire for what he calls a "new insurance exchange."

The Baucus plan would impose new fees on the health care industry to expand coverage to Americans without insurance, and it proposes a lower-cost coverage plan for those under age 25.

Baucus' committee remains the only congressional panel central to the issue that has failed to produce a piece of legislation on remaking health care. Three House committees and one Senate committee have already approved their versions of the bill; there is no single bill.

Confusion About What's In Obama's Plan

Rep. Charles Boustany, a heart surgeon from Lousiana who delivered the Republican response, agreed with the president that "much needs to be done to lower the cost of health care for all Americans."

And he declared that Republicans are ready to "work with the president for common-sense reforms that our nation can afford."

But Boustany, a member of the House Ways and Means Committee, said that one of the three House health care overhaul bills passed out of committee would add to government bureaucracy and the nation's debt, and it would cut payments to Medicare "while doing virtually nothing to make the program better for our seniors."

Obama dismissed that claim preemptively in his speech, saying: "If you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have."

It remains to be seen whether Obama's prime-time speech will put the Democratic-controlled Congress and Democrats feuding over the public option — on a clearer path toward health care legislation.

But for Obama, who says that Congress has agreed on about 80 percent of what the overhaul legislation should include, it provided a valuable opportunity to regain traction on the issue an opportunity that he used fully.

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