When Democrats need to sell the American people on a complex and beleaguered government project, there’s only one guy they call.
In a last-ditch attempt to persuade Republican lawmakers to work with Democrats on implementing the Affordable Care Act, the Obama Administration has enlisted the help of Bill Clinton. In a speech at the Clinton library in Little Rock, Arkansas, on Wednesday, the former president, whom Obama has called the “secretary of explaining stuff,” outlined why the law was needed and how it will work. “I have agreed to give this talk today because I am still amazed at how much misunderstanding there is about the current system of health care—how it works, how it compares with what other people in other countries pay for health care and what kind of results they get—and what changes are actually occurring now and are going to occur in the future,” Clinton said.
Clinton’s policy explanations, contained in a prepared text he read with glasses perched on his nose, were familiar to anyone with a basic understanding of how the new health care law operates. But he wrapped up his case for bipartisan cooperation by outlining flaws in the law desperately in need of repair that won’t be fixed without legislative action at the state and federal levels. This was notable because the Obama Administration has downplayed glitches and unintended consequences that may result from the law.
Some flaws in Obamacare seem like actual errors, according to Clinton. The law, for instance, requires large employers to provide health insurance to employees, but not their family members. This is the case even though spouses and children of the employees will be required by the law to have health insurance, but aren’t eligible for federal subsidies to buy coverage independently. “It’s obviously not fair and bad policy, but it’s not clear to me that anybody intended this,” said Clinton. “I think Congress should fix it.”
Clinton also said he believes Obamacare tax credits created for small businesses to help them afford health insurance for their workers are too small and limited to too few companies.
Clinton also pointed to what is probably the most pressing problem in the law’s design. Obamacare was designed to provide Medicaid coverage, through a large national expansion, to all Americans earning up to 138% of the federal poverty level (FDL). Those earning above that level but below 400% of FDL will be eligible for federal subsidies to buy private coverage. But the Supreme Court’s 2012 ruling that the Medicaid expansion must be optional for states has left legions of the working poor with no way to afford insurance. Those who don’t qualify for Medicaid in a state like Texas, where Medicaid eligibility is very strict and will remain so under Obamacare, won’t qualify for subsides unless they earn more than 100% of FDL. “You get the worst of all worlds,” Clinton said. “You’re too poor to get help…And this is a problem only the states can fix.”
Clinton’s ability to persuade Republican state lawmakers to suddenly begin working with the Obama Administration on implementation of the health care law after three years of resistance is limited at best. But at this stage, less than a month before the law’s health insurance marketplaces launch, the White House seems willing to try anything—even if it means admitting, through an intermediary, that the law is flawed and needs Republican participation to fix it.
“It is the law and I think we’ve all got an interest in trying to faithfully execute the law,” said Clinton. “To get one of the elected jobs, you actually take an oath to do that… We all get paid to show up for work and we need all hands on deck here.”