Hurdles Ahead For Health Care Overhaul

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President Obama has signed the health care bill. But both sides warn their work is not yet done. NPR health policy correspondent Julie Rovner talks about the next steps for the health care overhaul, and what it's been like to cover this story for the last year.

NEAL CONAN, host:

Just before boot noon, a beaming President Obama stood before supporters at the White House to celebrate passage of the health care bill.

President BARACK OBAMA: Our presence here today is remarkable and improbable. With all the punditry, all of the lobbying, all the game playing that passes for governing in Washington, it's been easy at times to doubt our ability to do such a big thing, such a complicated thing, to wonder if there are limits to what we as a people can still achieve. It's easy to succumb to the sense of cynicism about what's possible in this country.

But today, we are affirming that essential truth. A truth every generation is called to rediscover for itself, that we are not a nation that scales back its aspirations. We are not a nation that falls prey to doubt or mistrust. We don't fall prey to fear. We are not a nation that does what's easy. That's not who we are. That's not how we got here. We are a nation that faces its challenges and accepts its responsibilities. We are a nation that does what is hard, what is necessary, what is right.

Here in this country, we shape our own destiny. That is what we do. That is who we are. That is what makes us the United States of America. And we have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care.

(Soundbite of applause)

And it is an extraordinary achievement that has happened because of all of you and all the advocates all across the country. So, thank you. Thank you. God bless you. And may God bless the United States of America.

(Soundbite of cheers and applause)

CONAN: Moments later, the president used 20 pens to sign the bill. And a few minutes after that, a dozen state attorneys general filed suit charging that it's unconstitutional. And, of course, the Senate has yet to take up a set of changes adopted by the House of Representatives. Nevertheless, very broadly speaking, a piece of social legislation pushed by both Presidents Roosevelt, by Richard Nixon and by Bill Clinton became law today.

If you followed the debate over the years and this past weekend, what moment stood out for you? 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our Web site at npr.org, just click on TALK OF THE NATION.

NPR health policy correspondent Julie Rovner was in the capitol on Sunday and at the White House today and she joins us here in Studio 3A. Julie, nice to have you with us, as always.

JULIE ROVNER: Nice to be here.

CONAN: And there was a moment today at the White House where the president mentioned that legislative leaders had taken their lumps in this debate and somebody shouted out: Yes, we did.

(Soundbite of laughter)

ROVNER: Yes, somebody did. And I'm pretty sure that somebody was Bart Stupak from Michigan. I looked up and he was kind of smirking and, boy, nobody took more lumps than Bart Stupak did. He, of course, was the leader of those anti-abortion Democrats who got their way on the House bill and then sort of got their way but really didn't there, Sunday night, were the last group to come aboard, if you will, to vote for the Senate bill.

They really didn't like the abortion language in the Senate bill, ultimately got the president to issue an executive order. The pro-choice Democrats weren't very happy about it. But basically they say that the executive order just says that the president will abide by what the Senate bill says. But certainly, it got all of those anti-abortion Democrats to come aboard and vote for the bill, which they really wanted. I saw a number of them standing up there.

Nick Rahall from West Virginia said, this is the most pro-life bill I will ever have voted for in my 34 years. Meaning, a bill that gives health insurance to that many people. It was really sort of a remarkable moment.

CONAN: You also had a remarkable group of people there. John Dingell, you couldn't help but notice him, who has been pushing for this, what, his 55 years in Congress, and his father before him.

ROVNER: And his father before him. I spoke to him Sunday morning and I asked him, you know, had it really dawned on him yet that this was actually going to happen after he's introduced a bill in every single Congress since he has been in Congress, all those 55 years, in honor of his father, who of course introduced the Dingell-Murray-Wagner bill in 1943 when FDR was still president, a national health insurance bill.

And I think the junior Mr. Dingell, who's now 83 years old, I think had - it had not quite sunk in yet. But he did say to me that he wouldn't have stayed in Congress all these years if he didn't think that that -this day would actually come sometime.

CONAN: And what was it like there in that room at the White House today?

ROVNER: It was pretty electric. It was not as serious as I would have expected, you know, waiting for the president, who's, you know, always a little bit late. It was all House members and Senate members, that was all who would fit in the East Room.

CONAN: Mm-hmm.

ROVNER: So it was all legislators. Of course, the people who made it happen. And they were all taking pictures. Everybody now brings their camera - either their regular cameras or their cell phone cameras. And they were up posing.

And, in fact, the biggest boo came when one of the White House staffers got up and asked that please, when the president actually goes to sign the bill, would they not stand up and hold their cameras up, blocking the professional photographers from getting the money shot. And they all booed, like, what do you mean we can't take the picture of the president signing the bill? It's like, don't you want to see it on the front page tomorrow? So it was...

CONAN: As we were playing that clip of tape, we heard the clickity, clickity, clickity, clickity of the cameras. I have to say, Julie, you were taking pictures too.

ROVNER: I did, but I wasn't blocking anybody.

(Soundbite of laughter)

ROVNER: I was standing in front of a photographer who was on a ladder.

(Soundbite of laughter)

CONAN: So we've posted Julie's picture that she took in the White House today at the signing ceremony on our blog at - on our Web page at npr.org. Just click on TALK OF THE NATION so you can see an unprofessional shot of the scene you'll see tomorrow on the front page of the newspapers.

ROVNER: Very unprofessional. I am not a professional photographer. And I was using my BlackBerry. I didn't take an extra camera.

(Soundbite of laughter)

ROVNER: I had recording equipment to take with me.

CONAN: And this takes us back to Sunday and takes us back to Saturday. And, Julie, it takes us back - how long have you been covering health care?

ROVNER: This month marks my 25th - the beginning of my 25th year of covering health care policy on Capitol Hill.

CONAN: I don't have to tell you, that's a very long time.

ROVNER: I was six when I started.

(Soundbite of laughter)

ROVNER: No.

CONAN: There was a moment just a couple of months ago when it looked like this was not going to happen.

ROVNER: Yes, there was. And actually, I was not one of - you know, I was one of those few people who really believe that it wasn't dead and a lot of people laughed at me. I just thought they had come too far to let this die. I mean, the stakes, particularly for the Democrats, were such that they had - they'd all voted for this in the House and many of them in the Senate, and that the electoral stakes were just really abysmal if they - that they needed to find a way to resurrect it. And indeed, they did.

You know, whether you like this bill or hate this bill - and there are a lot of people who hate this bill - I think the Democrats really needed for their own sort of, you know, electoral salvation, needed to find a way to make something happen. And they did and it wasn't pretty. Boy, was it not pretty at times.

But they really sort of - and I think Nancy Pelosi really showed herself as a strong House speaker, the likes of which we have really not seen in a long time, because that - getting the House to vote for the Senate bill, with all of those sweetheart deals and...

CONAN: She said two months ago...

ROVNER: Yeah.

CONAN: ...I don't have the votes for this.

ROVNER: That's right. And she didn't. But really bringing this together and this - they're still walking this tightrope. The Senate still has to do this budget reconciliation bill. And it's - you know, the Republicans are dead set against it, going to do everything they can. You know, they're not across this tightrope yet. But getting it this far is just a remarkable - you know, even if you're not for it, you have to admire the legislative acumen that they've used to get it to this point.

CONAN: We want to hear from our listeners what the most interesting, the most telling moment that they remember from this, well, perhaps going back 25 years, Julie. 800-989-8255. Email us: talk@npr.org.

And Corrine(ph) is on the line, calling from Tucson.

CORRINE (Caller): Yes. I wanted to first of all thank NPR for the incredible coverage that you've done of this issue. You never got tired of it. The coverage is always honest. It was always up to the minute. And for those of us whose lives literally depend on the outcome, it was an amazing resource. So thank you very much for that coverage.

CONAN: And thank you for the kind words.

CORRINE: I'm a 57-year-old woman. I own a small business. And interestingly enough, I'm insured under a public option in Arizona. We have a small business health insurance plan that allows you to get insurance. But we have two problems. One is we have two Republican senators who don't understand that this is a pro-business plan. And the other is that we have a very conservative Republican legislature that is constantly trying to take away this very small and not really subsidized plan.

And I remember one day, not too long ago, there was a moment when the bill was going to include a provision that would include everyone over the age of 55 in Medicare. And I thought to myself, I'm never going to worry about my health insurance again, and I burst into tears because the relief was so palpable to me. It's such a huge issue in my life and in our business.

CONAN: That did not survive, that part of the bill.

CORRINE: And then it went away.

(Soundbite of laughter)

CORRINE: Exactly. But I'm glad that the bill passed. I'm (technical difficulty) that it's going to make things better. But I wouldn't be surprised at all if Arizona (unintelligible) legislatures that decides to (technical difficulty) of everything that will be of advantage to its citizens.

CONAN: Well, Corrine, well, I have to see how the opt-out attempts fare with the courts and, of course, the other lawsuit that's being brought by the states attorneys generals. But thank you very much for the phone call. We appreciate it.

CORRINE: Thank you.

CONAN: Bye-bye.

ROVNER: And there are tax credits for small businesses begin this year. So there's a 35 percent tax credit starting this year for small businesses who offer health insurance to their workers.

CONAN: It's interesting, in Arizona, the governor just, as part of budget cuts because of their - well, Arizona, like a lot of other states, is in huge budget problems, but cut the CHIP program, the health care program for kids who weren't covered under Medicaid. Would this bill do anything for those kids, I think 47,000 of them, in Arizona?

ROVNER: That's a good question. There are Medicaid expansions in this bill, but they don't start until the year 2014, and those are for childless adults. So I don't know actually that this bill would particularly help the states. There are other bills that are going through that have more money for Medicaid that might do more for Arizona and its CHIP program.

CONAN: We're talking with NPR's health policy correspondent Julie Rovner, who's been covering health policy for 25 years now, obviously was in the House of Representatives on Sunday night, when finally the House passed the measure by, well, a whopping majority, and then at the White House today, when President Obama signed the legislation into law. She mentions there's still a lot of ways yet to go. The Senate still has to adopt the House so-called fixes and there will be legal battles as well in the courts. But we're interested, on this day, when health care finally became the law of the land, what's your most interesting moment of this debate has been. You're listening to TALK OF THE NATION from NPR News.

Let's go next to Jeff(ph). And Jeff with us from St. Henry in Ohio.

JEFF (Caller): Hi. Yes. The most memorable moment for me was hearing an interview with president Obama when he was asked what - he was asked whether or not he was concerned about being re-elected. And his response was that he would rather be - something along the lines of that he would rather be an effective one-term president that an ineffective two-term president.

And it really struck me. And I don't know, you know, one can always doubt the intentions and the comments of any politician, but I was impressed by it. And I've heard some members of Congress repeat those kinds of sentiments, that they did the right thing regardless of the political fallout that may come to them in the next election too by voting for it.

And I hope that some of those thoughts are genuine. And I - it impressed me and struck me and I hope that people's hearts are in the right places.

CONAN: Jeff, thanks very much for the phone call. Appreciate it. The president, down the stretch, was saying this may not be great politics but it's the right thing to do. You were talking about the electoral consequences for the Democrats, if after all this effort, they failed to pass it.

ROVNER: Yes. But this was a very risky vote for, you know, a number of Democrats, certainly, you know, in districts that are, that lean Republican, a number of Democrats from districts that voted for John McCain in 2008. This was a very, very difficult vote for them. And of course, you know, the polls at the moment don't look that good in terms of the bill. But there's certainly hopes that, you know, once people find out what's actually in the bill instead of what's just being said about it - or I guess what's in the law now as of about noon, that people, you know, will start to come around.

And there's certainly evidence that, you know, when you go - when you look at the polls about some of the provisions of the now law, those are much more popular than when you just go out and poll, you know, what do you think of the President's proposal or the proposal in Congress. So there is reason to believe that that public opinion will likely start to rise on a lot of these things.

And, you know, of course, the party in power - the president's party tends to lose seats in the mid-term elections anyway. So it's - they're certainly bold. Things don't look good for the Democrats for other reasons. But we'll have to see.

CONAN: Akron, Ohio, Tom(ph) is on the line.

TOM (Caller): Hi.

CONAN: Go ahead, Tom.

TOM: Yeah. I was just - the most memorable moment for me was definitely the roundtable discussion that the president had with the Republicans.

CONAN: The White House summit?

TOM: Yeah. Exactly. You know, I'm a university student here in Akron. And I'm taking a health economics course this semester. So all of the issues that are raised in the policy that's been proposed, it was clear to me why they were so important. And I was so afraid that this whole thing was just going to be tanked because of partisan politics.

But the president, you know, like the previous caller just said, that he was more concerned about being an effective president than a two-term president, you know, it was clear to me that the way that he approached everything in that roundtable, that summit, it - he was approaching things, you know, this is what we need to do for the health of the nation. And I'm just - I'm amazed that he actually ended up pulling it off.

CONAN: Well, Tom, I correct myself. It was the Blair House summit, it was so-called, right?

TOM: Oh, right. Right.

CONAN: But it was across the street from the White House. Anyway, thanks very much for the call.

TOM: Thank you.

CONAN: And there was a moment again as the president was being introduced by Vice President Biden who was, well, he was Vice President Biden, he was effusive, that's what he does. But he was saying, I know I'm embarrassing my friend here, but I'm going to go on for another minute because you have done something that all of your predecessors have attempted to do but failed to do.

ROVNER: Yes. And it was, you know, and the president went on and ticked off all of those predecessors. Now, in fact, the president came in with the wind at his back in the sense that a number of opponents, you know, of a health overhaul were for it this time. I mean, the insurance industry has been on both sides of this all year. But certainly, you know, the American Medical Association, long time opponent, was for this. The drug industry, long time opponent, was for this, the American Hospital Association.

Business, also been back and forth. But in general, business was for this. So a lot of obstacles that had been in the way of previous reform efforts were onboard this time, or at least held their fire. So that certainly helped. I mean, what this really became was a very partisan issue, which it really hadn't been before. Before, there at least had been some bipartisan agreement that something had to be done about the health care issue.

This time, it really became the Republicans saying, you know, we would like to make this president and this party fail so that we can take back the majority. So oddly enough, this was a very different fight than it had been the last several times we've seen it fought out.

CONAN: We just have a few seconds left. Julie, we haven't asked you, in all those 25 years, what's the one moment that stands out for you?

ROVNER: Boy, you know, I think, well, in this fight, I think it actually was when the president went to the Republican issues retreat in Baltimore, which we really expect them to turn the cameras off when he took the questions and they left them on. And at one point, I think one of the Republicans said, oh, Mr. President. I'm sure you have to leave now. And he said, oh, no. I'll take a few more. I'm having fun. I mean, and he just went to town...

(Soundbite of laughter)

ROVNER: on the Republican questions just - and I think that was where he was really kind of got his mojo back on this issue. And I think things just started going from there.

CONAN: Julie, I think there may be a few health care issues left to cover.

ROVNER: I think there will be.

CONAN: Julie Rovner, NPR health policy correspondent. She's followed almost every moment of this debate over the years and will continue to. She was kind enough to join us today here in Studio 3A.

I'm Neal Conan. It's THE TALK OF THE NATION from NPR News.

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