Obama’s Health Care Record

Medicare, Medicaid and the 2010 health law will continue to be hot topics this presidential campaign season. KHN has assembled this resource page to help track President Barack Obama’s health policy record from his 2008 campaign positions to the enactment of the health law and his proposals to control federal health care spending.

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Obama on Medicare and Medicaid:

Obama repeatedly touts provisions in the 2010 health law that aim to expand coverage and bring down costs in so-called entitlement programs. The law’s approach includes the expansion of Medicaid; the creation of the Independent Payment Advisory Board, accountable care organizations, and other payment pilots and demonstration projects to reward providers for delivering quality — rather than quantity — of care; and various cuts to Medicare providers and insurers. The administration has made clear that it is willing to go beyond the changes included in the law, particularly in the Medicare program, to ensure its solvency.

• The administration proposed additional cuts in its fiscal year 2013 budget proposal, including reducing Medicare spending by $302 billion over 10 years and Medicaid spending by $56 billion over the same period. For example, the budget, which was released in February 2012 but not passed by Congress, would:

• Apply a single blended matching rate to Medicaid and CHIP.
• Phase down Medicaid provider tax threshold from 6 percent to a low of 3.5 percent in FY 2017 and beyond.
• Give the IPAB authority to limit Medicare spending growth to GDP plus 0.5 percent, rather than GDP plus 1 percent.
• Increase income-related premiums under Medicare Part B and Part D.

• During the 2011 budget negotiations between Congress and the White House, Obama considered far more dramatic changes to Medicare, such as increasing the Medicare eligibility age from 65 to 67, in exchange for Republican agreement to raise revenues, according to reports.

• In Sept. 2011, after negotiations failed, Obama released a plan to cut the national deficit, including $320 billion in cuts to Medicare and Medicaid over 10 years (many of which found their way into the president’s latest budget proposal). The plan did not include increasing the Medicare eligibility age.

• The administration has opposed Republican proposals to turn Medicaid into a block grant for states.

• Obama has strongly opposed Republican proposals to change Medicare for future beneficiaries (people currently 55 or younger) into a defined-contribution program, in which they would receive a set amount of money each year to buy health coverage, rather than the program’s current defined-benefit design.

• In an April 2011 speech, Obama set forth a plan for reducing the deficit and changes to Medicare and Medicaid:

“But let me be absolutely clear: I will preserve these health care programs as a promise we make to each other in this society. I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs. I will not tell families with children who have disabilities that they have to fend for themselves. We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations.” – Obama, speech, April 13, 2011

Obama on health reform philosophy:

• The 2010 health law, which is considered to be the Obama administration’s signature legislative achievement, has the dual objectives of expanding health coverage and containing costs. Among its key provisions is a requirement that nearly all Americans obtain health coverage, a marked expansion of the Medicaid program (see Medicare and Medicaid sections above for more details), the creation of health insurance exchanges and an array of consumer protections including bans on pre-existing condition exclusions.

• In 2008, Obama made efforts to overhaul the health system a central theme in his presidential campaign. His reform proposal included a requirement that all children have health insurance, and that most large employers either offer employee health benefits or contribute to a new public program. He also advocated expansions for Medicaid and CHIP. He advanced a number of the same types of consumer protections that ultimately were included in the health law. He initially opposed the individual mandate.

• During the campaign, Obama advanced a proposal for a refundable tax credit to help small businesses buy health insurance for their employees. The 2010 health law creates a tax credit for small businesses (fewer than 25 employees) that provide health coverage to their workers.

• He has consistently supported proposals to increase transparency related to health care costs and quality, such as the health law’s medical-loss ratio requirement and requirements to collect and report on health care quality measures such as preventable medical errors, hospital-acquired infections, and others.

• During his 2008 campaign and later as part of the health law, Obama advocated for comparative effectiveness research to help physicians and patients make health care decisions.

Obama on the health care marketplaces:

• Obama has opposed medical liability tort reforms that impose federal caps on jury awards in malpractice cases. Since taking office, though, his administration has launched a Patient Safety and Medical Liability Reform Demonstration program to help states test new ways to improve patient safety, reduce the incidence of frivolous lawsuits and bring down the cost of liability insurance premiums. In his 2011 State of the Union address, he signaled openness to “medical malpractice reform to rein in frivolous lawsuits,” but he has stopped short of changing his position opposing federal caps on damage awards.

• He has supported the reimportation of prescription drugs from other developed countries if the drugs were safe and cost less than they do in the U.S. As a senator he co-sponsored related legislation and early in his presidency continued to view the idea favorably, but has since stepped back from the issue.

Obama on birth control, contraception and other women’s health issues:

• As part of the 2010 health law, many insurance plans are required to fully cover birth control without co-pays or deductibles as part of women’s preventive care. Plans also must cover women’s preventive services such as well-woman visits, mammograms, birth control pills, and screenings without copays or deductibles. In addition, insurance companies will no longer be able to charge women higher premiums than men.

• Obama opposes efforts to prevent federal funding for Planned Parenthood to provide health services such as mammograms and other preventive health screenings. During a campaign event speech in July, Obama said:

“We are moving forward. We’re not going to roll back funding for Planned Parenthood … because I think women should have control over their health care choices just like everybody else does. We’re not going backwards.” – Obama, speech at a campaign event, July 27, 2012

• He supports Roe v. Wade and opposes efforts to amend the Constitution to overturn it; is on record urging that state “partial-birth” abortion bans include exceptions for cases where the pregnant woman’s life is in danger.

Deep Reads:

For more detailed information about the law and its implementation so far, KHN’s resource page Explaining Health Care’s Hot Topics includes an array of issues addressed by the health law. Here are some of the highlights:

FAQ: Obama V. Ryan On Controlling Federal Medicare Spending (Werber Serafini, 5/3).

FAQ: The Obama Administration’s Compromise On Contraception Benefits (Carey, 2/11).

The IPAB: The Center Of A Political Clash Over How To Change Medicare (Vaida, 3/22).

A Guide To Health Insurance Exchanges (Appleby, 7/10/2011).

FAQ: The Shrinking Medicare Doughnut Hole (Werber Serafini, 2/11/2011).

FAQ On ACOs: Accountable Care Organizations, Explained (Gold, 10/21/2011).

Sarah Barr, Matthew Fleming, David Schultz and Stephanie Stapleton contributed.