Following the elections, congressional Republicans are pushing once again for major reforms to your health care act.
QUESTION: In the past, you’ve said you hope some good ideas, that you don’t want to undermine the bill. Can you tell us what specific ideas you’re ruling out?
On health care, there are certainly some lines I’m going to draw. Repeal of the law, I won’t sign. Efforts that would take away health care from the 10 million people who now have it and the millions more who are eligible to get it, we’re not going to support. In some cases, there may be recommendations that Republicans have for changes that would undermine the structure of the law, and you know, I’ll be very honest with them about that and say “look, the law doesn’t work if you pull out that piece or that piece…..”
QUESTION: (inaudible) the individual mandate one of those lines that came across?
OBAMA: Yeah, the individual mandate is a line I came across because the concept, borrowed from Massachusetts, from a law instituted by a former opponent of mine, Mitt Romney, understood that if you’re providing health insurance to people through the private marketplace, then you’ve got to make sure that people can’t game the system and just wait until they get sick before they go try to buy health insurance. You can’t ensure that people with preexisting conditions can get health insurance unless you also say, while you’re healthy, before you need it, you’ve got to — you’ve got to get health insurance…..
So the core aspects of the law are off the table. This will produce a shutdown
QUESTION: Keystone XL pipeline, they will send you legislation on that. They will ask you to repeal the medical device tax as a part of a funding mechanism of the Affordable Care Act….
Obama:… — OK — medical device tax — you know, I’ve already answered the question. We are going to take a look at whatever ideas — let me take a look comprehensively at the ideas that they present. Let’s give them time to — to tell me. I’d rather hear it from them than from you
The agreement zone that Obama is sketching out is one that does not significantly alter the three legged stool of private market near universal health insurance. Those three legs are community ratings, subsidies and participation enforcement mechanism. He is laying down a hard marker on the individual mandate but I think the Democratic policy wonks who we know he listens to would be willing to trade an individual mandate for other participation enforcement mechanisms like the Medicare Late Enrollment Penalty scheme or very narrow open enrollment windows and much tighter qualifying event triggers as long as they do the same thing. Those are the three non-negoatiable items from his point of view, and since he has both a veto pen and at least a third of one chamber, those are enforcable views.
Notably he does not care too much about the medical device tax. That is a trading chip with low value. It is enough to cover the big blind.
Also of note is no mention of the employer mandate. The Urban Institute argues that getting rid of the mandate does also nothing to change coverage while screwing some workers and adding administrative burden and perverse incentives to employers:
Our analyses as well as that of others find that eliminating the employer mandate will not reduce insurance coverage significantly, contrary to its supporters’ expectations. Eliminating it will remove labor market distortions that have troubled employer groups and which would harm some workers. However, new revenue sources will be required to replace that anticipated to be raised by the employer mandate.
The National Federation of Independent Business and other conservative groups also want to get rid of the employer mandate. The question that could provoke significant conflict would be whether and how to replace the lost revenue. If there is no replacement, this is an easy policy and political win for everyone. The Republicans get a pound of flesh, their supporters are happy, while Democrats get a ‘mend don’t end’ moment as well as better coverage for low wage employees on the Exchange.