Little Rock, Arkansas–(ENEWSPF)–September 4, 2013.
PRESIDENT CLINTON: Thank you very much. Thank you. Thank you very much, Governor, Senator and Mrs. Pryor, Speaker Carter, Senator Lamoureux, Attorney General McDaniel, all the other officials who are here and my friends of many years. First, I want to thank Mara for her introduction and for sharing a little of her story.
Today, the work my foundation does on health care in America largely concentrates on the issue of childhood obesity and the role that plays in dramatically increasing rates of type 2 diabetes, the kind you get from living. But we can never forget that there are people like Mara who are born with conditions that lead to type 1 diabetes and that these two conditions combined account for an enormous percentage of health care spending because of the consequences that they bring to the people who bear them and their families, and if not adequately treated, can shrink, rather than increase, the horizons of our gifted young people. So thank you for being here.
My work today in health care is mostly, as I said, in trying to contain and reduce childhood obesity and trying to improve the health care of the baby boom generation, so we don’t bankrupt all the rest of you. But around the world, I work with people who have no money, no health systems, no nothing, all the things that we take for granted.
However, all this work began when I was attorney general worrying about the quality of health care in Arkansas nursing homes, and when I was governor trying to deal with the fact that there were still substantial numbers of rural communities where people had virtually no access to health care, where it was not possible to deliver a baby safely, where the infant mortality rate was well above the national average.
So I’ve been involved in this subject for a long time, and I have believed all my life that the role of government is to work with the private sector and the non-governmental groups and communities and ordinary citizens, essentially, to empower people to have better life stories. And that’s what this whole issue is about.
I have agreed to give this talk today because I’m 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.
So I have done something unusual for me. I actually wrote this whole thing out. I am going to try to use very few adjectives, explain how this works, what’s been done, what has to be done, talk about the remarkable work that has been done in Arkansas, thanks to the governor and the leaders of the House and Senate and bipartisan coalition here, and what lies ahead.
And I’m going to argue, as best I can, that we’d all be a lot better off. Whether we supported or opposed the health care reform law, whether we like it or don’t, we’d all be better off working together to make it work as well as possible, to identify the problems, and to fix them, instead of to keep replaying the same old battles.
That’s my belief, and I hope I can persuade you that it is correct and that we should support leaders like the governor and the leaders of the House and Senate here all over America, who are just trying to figure out what’s best for the people and get the job done.
In 2010, nearly 100 years after President Theodore Roosevelt first proposed affordable health care access for all Americans, the Congress adopted and President Obama signed the Affordable Health Care Act.
The bill was designed to address the two biggest problems of the American health care system: its extraordinary cost and its lack of coverage, and to do so in a way that improves, not weakens, the quality of our health care.
Before the bill passed, just 84 percent of the American people had insurance coverage, and we were spending almost 18 percent of our GDP, 17.9 percent of our national income, on health care. That’s about $2.5 trillion.
Other countries at our income level cover everybody and do it for far less cost, between 9 percent of GDP that’s Japan and 12 percent of GDP that’s the Netherlands and Switzerland, with countries like Germany and France in the middle.
The difference between 17.9 percent and 12 is $1 trillion a year, $1 trillion that could go to pay raises or to hire new employees or to make investments that would make our economy grow faster or to provide more capital to start small businesses or expand others or to support diversifying and strengthening agriculture, you name it. A trillion dollars is a lot of money to spot our competitors in a highly competitive global economy.
It would be worth it if we got $1 trillion better health outcome, but that’s not what the research shows. It shows we ranked first by a country mile in the percentage of our income we spend on health care and no better than, in all the surveys, 25th to 33rd among all nations in our health outcomes.
Health care costs keep wages down, business profits down, economic growth down, accounted for 60 percent of the personal bankruptcy filings before the economic crash. And every single year for an entire decade now, they have been going up at three times the rate of inflation, manifesting themselves to ordinary Arkansans in higher premiums, higher copays, higher deductibles.
The cost is so high for several reasons. Almost everybody pays health care providers for each procedure, medical device, or service, not for the overall quality of health care.
In most states, health insurers have almost no competition. In 80 percent of our states, one or two companies have 80 percent of the market. Therefore, there’s very little constraint, either from competition or regulation, on limiting prices or their ability to not cover people with preexisting conditions or to do so at unaffordable prices.
The paperwork costs of our system, because there are so many different people paying into it, are incredibly high, about a dime on the dollar higher than the next most expensive country in the world. That’s a lot of money, and we all pay for that.
We also pay more for drugs than people in other wealthy countries, about $70 billion a year more. And, as I said earlier, our lifestyle has led to a higher number of preventable problems than citizens of other countries have, especially diabetes and the conditions related to it.
Now, the Affordable Care Act is designed to address all these issues by making health care coverage available and more affordable to all Americans, by improving health care delivery and paying for it based on its quality, not the number of procedures performed and products provided, and by creating more affordable options for uninsured people and small businesses. That’s what Arkansas Governor Beebe and the legislators are leading the country, I think, in bipartisan efforts to do.
Now, the law has generated a lot of opposition, as we all know. It has been attacked from the left, believe it or not, for not having a public option, that is, for leaving the insurance companies with too large a role in health care. And it’s been attacked from the right for increasing the role of government in health care delivery.
People who are already insured have been told they are about to lose what they have and like. Small businesses have been told they will be priced into insolvency. Poor people without coverage have been told they won’t be able to afford it when it comes.
In Congress, there have been 40 votes to repeal this law, but no real alternatives presented to fix the current system. Opposition has been fierce in many states, which matters because states are given a very big role in implementing this, something I like.
They are eligible for a substantial increase in Medicaid funding to provide coverage to workers with lower incomes and for funds to create and run health care marketplaces, designed to allow uninsured citizens and small businesses to shop for policies that are adequate and more affordable. Several states have declined to participate in either the Medicaid expansion or the marketplaces or both, leaving money on the table for other states and the health insurance marketplace to the federal government to set up and run.
Now, as I said, I think we should all work together to implement this law, whether we supported its passage or not, for several reasons:
Number 1—as I’ll try to demonstrate in a minute—it’s better than the current system, which is unaffordable and downright unhealthy for millions of Americans.
Number 2, it gives states the chance to devise programs that work best for them and their populations.
Number 3, not cooperating means the states’ taxpayers will pay for this and the money will go to somebody else, somewhere else with consequences, which I will outline.
Number 4, the problems with the law—and there are some—you can’t change a complex eco-structure like American health care this much without creating some problems, so there are some. But they can best be solved if we all work together to fix them.
Number 5, this does give us the best chance we’ve had to achieve nearly universal coverage, provide higher quality health care, and lower the rate of cost increases, which we have got to do, in a competitive global economy.
And, finally, it is the law, and I think we have all got an interest in trying to faithfully execute the laws. If you get one of these elected jobs, you actually take an oath to do that.
So I’ll do the best I can in plain language to say how the law works, what’s happened so far, what has to be done now, what the unsolved problems are, and why we’re better off working together to fix those problems than continuing to fight to repeal the law, or even worse, to make sure its implementation is a failure.
Several provisions of this law—let’s talk about where we are now. Several provisions of the law have already taken effect. As a result, more than 3 million young adults under 26, like Mara, now have health coverage on their parents’ plans. 6.6 million seniors pay less for prescription drugs as the law begins to close the so-called “donut hole” in the Medicare drug program. 105 million Americans have seen the limits, the lifetime limits, on their insurance coverage abolished, and preventive care is less costly for them. 17 million children with preexisting conditions—17 million—can no longer be denied coverage or charged higher rates for it.
Almost 27 million women and 26 million men have been extended preventive benefits with no cost sharing, including mammograms, cervical cancer screening, colorectal treating, cholesterol and blood pressure tests, stop smoking programs, flu and pneumonia shots, prenatal care, and regular child visits.
12 million people have received rebates from insurance companies because companies must now spend 80 to 85 percent of your premiums, depending on the size of your pool, on your health care, not keep them for profits and promotion. This has also been a major factor in keeping rates lower than they would otherwise have been and slowing the rate of increase. Total savings from rebates and lower insurance rates are estimated in 2012 to have been $3.9 billion.
What does this mean for Arkansas, where nearly 500,000 people are uninsured, including about 25 percent of our working-age people, one in four of them? Well, 865,000 people no long have lifetime limits. More than 32,000 seniors have seen a reduction in their drug price. 35,000 young people are now covered on their parents’ plans. More than a million people are eligible for preventive services without a deductible or copay. And more than 120,000 Arkansans have received about $3 ½ million in rebates on their insurance policy.
Now what? What’s next? In January, insurance companies in the individual and small group markets will no longer be able to charge higher rates or deny coverage based on preexisting conditions. This affects a lot more people than you think.
It is estimated that 129 million Americans under age 65, roughly one in two of us, are at risk because of preexisting conditions, and therefore, pay some higher insurance rates.
But let’s be realistic. People that pay humongously higher rates or can’t get coverage at all are a much smaller percentage than that. But there are still a good number, and I’ll bet you everybody in this audience knows somebody with a severe preexisting condition that made them uninsurable or increased their rates.
So after January, these groups in the most severe conditions are concentrated in people aged 50 to 64, all those irresponsible young people. It’s amazing what you can get away with saying when you’re 67. Anyway, they are concentrated there. They can’t be charged higher rates, which is an opportunity and a challenge. I’ll talk more about that in a minute.
Also, women can no longer be charged higher rates than men, which was a common practice before.
And 8.7 million of them with individual coverage will have maternity services for the first time. Now, what about the uninsured? How are they going to get insurance? How will it be more affordable? How will it affect small business?
Currently, more than 41 million Americans, mostly low and moderate income Americans, have no health insurance, roughly, 22.5 million men and 18.5 million women.
The racial background is something like this: There are a little over 10 million Latinos, nearly 7 million African Americans, about 13 million whites, and the rest are Native Americans, Asians, Pacific Islanders. Included here are 1.3 million American veterans not currently enrolled in the VA. What about them?
People with incomes of up to 138 percent of the poverty line—that’s 15,860 bucks for individuals and $32,500 for a family of four—will receive support for their coverage through Medicaid payments to the states. I’ll come back to what Arkansas did in a minute.
People with incomes between 138 percent of the poverty and 400 percent of the federal poverty line will be eligible for tax credits for individual and family policies on a sliding scale. The lower your income, the higher the credit.
Here’s how it works. An uninsured person can log onto a national site, healthcare.gov, or a state site and shop for the most affordable appropriate policy. The prices, which include the discount for the tax credit, will be shown. And when a policy is ordered, the tax credit will actually be automatically sent by the government to the insurer, so there’s no other hassle for the person who is buying the insurance. You just pay what the computer screen says you owe.
To get this done, you do have to sign up on the state or federal website or at a designated call center between October 1st and March the 31st. That’s what’s about to happen. That’s what all these folks have been concerned about. That’s what they have been working on.
The toll-free national number is 1-800-318-2516. And again, the website is healthcare.gov. You don’t have to remember that if you live in Arkansas, and I’ll tell you why in a minute.
Look how Arkansas is handling this. Currently, there’s a massive education and outreach program to the half a million people who don’t have insurance. About half of them, 250,000, are at or below 138 percent of the federal poverty level. They are eligible for Arkansas’ unique Private Option plan. This was a bipartisan initiative led by Governor Beebe, supported by the leaders of the House and Senate and other Republicans to replace traditional Medicaid expansion with a plan to use the federal dollars to help eligible Arkansans to buy private insurance through the Arkansas marketplace.
Insuring lower income working families will help not only them, but as anybody who has ever worked in a hospital or been on a hospital board knows, it will dramatically reduce the burden of uncompensated care to health care providers. That burden was $338 million in Arkansas in 2010.
Today that burden all over America is just normally shifted as a matter or requirement to people who have insurance, which means it’s kind of a hidden tax. You pay higher insurance rates to pay for the uncompensated care that your health care providers are giving to people that they can’t bear to turn away. Nobody wants to turn them away, but they ought to be reimbursed in a more direct and fair fashion.
Now, whether or not you agree with the Affordable Care Act, Arkansas’ citizens are going to pay for it, just like citizens of every other state. So in deciding whether you support the fact that this Private Option is set up and will later have to be funded by the legislature, I think, in February, you should consider what turning back the money means. And keep in mind, some states have done this.
But as the governor said to me, he said, “This doesn’t make any more sense than turning back federal highway funds.”
We pay 18.3 cents a gallon in federal gas tax. How would you feel if somebody got up and gave a speech saying, “I don’t really like some of the requirements that the Federal Highway Administration puts on us if we take this federal money, so why don’t we just not take it and send our money to Texas”? You would think if somebody said that, they were three bricks shy of a full load. It doesn’t make any sense for us to do that, and it will aggravate the burden of uncompensated care substantially.
Now, by 2015, small businesses of more than 50 employees also have to provide insurance for their employees or face paying a penalty. Without this Private Option, a lot of our small businesses, most of whom have far fewer than 50 employees—but the ones that are covered, without this Private Option, they couldn’t afford to provide insurance. And there are a bunch of people with fewer than 50 employees that would like to provide insurance. And without the Private Option, there’s no way in the wide world they could do this.
So it’s a real boon, but there’s something else. If you’ve got more than 50 employees, you’re going to have to pay a penalty in 2015 if you don’t provide the health care. The aggregate cost of those small business penalties is $38 million. Is that right? That’s what I thought. I think I remembered that. That’s like a $38 million small business tax if you don’t embrace the Private Option.
So my view is that Arkansas did a good thing, a bipartisan thing, a practical thing. It will help a lot of people, and the rest of us ought to get behind and help them to stay with the program.
Now, what about people who are uninsured who won’t be covered by the Private Option because their incomes are above 138 percent of the poverty line? Well, if they’re between 128 and 400 percent, they can go to the national website, healthcare.gov, or the state site. It’s called arhealthconnector.org. And there’s a phone number for people who don’t have a computer, (855) 283-3483. And you just shop for the best value policies. The buyers are eligible for tax credits, which will be forwarded automatically to insurers, once they make a decision, as I just said. To simplify the selection process, individual and family options are organized by categories: bronze, silver, gold, and platinum. It’s like the Olympics. The bronze policies have the lowest costs and the least coverage. Silver is next, then gold. And platinum has the highest cost and the most coverage.
There’s also, for young buyers who are just over 26, a special catastrophic option, but it’s not eligible for the tax credit. So, actually, most young buyers will be better off picking a bronze option and getting the tax credit. It will probably prove out to be cheaper than the catastrophic option. 1
What about small businesses? Although businesses with 50 or more employees aren’t required to cover their employees until 2015, they can do so because they will have their own marketplace that’s called SHOP, Small Business Health Insurance Options. Or if they already offer insurance, they can just keep their present plan.
There are tax credits for small business based on average wages, which go up to 35 percent this year and up to 50 percent next year. But beginning next year, it’s only for those that participate in the marketplace, and that’s something, I think, Congress needs to reevaluate, as well as the size of the credits. I’ll say a little more about that later.
Now, if you put all these people in coverage, won’t it drive up the price of health care? So far, given the significant improvements that have already been implemented that I mentioned earlier, the answer is “no.”
For the last three years, the average increase in national health care spending and in health care spending here in Arkansas has hovered around 4 percent. That’s the smallest increase in 50 years.
Now, some of it was due, at the beginning of that three-year period, to the hangover from the financial crash in 2008, but not anymore. There are other things going on. Medicaid and Medicare costs, for example, are going up at less than economic growth. And Governor Beebe told me this morning the last time that happened was in 1988. That was in the dark ages when I was governor.
So I think this is important to note. There is something going on here. We are learning how to lower the inflation rate. For most of the last decade, the medical inflation rate was three times the overall rate of inflation, and that’s how we got this huge gap of spending 17.9 percent of our income on health care when nobody else was higher than 12. So I think there’s something going on here.
There’s also something else you should know. There is one lifetime limit which was put into this law, which I like. Under the new law, there is a limit on the percentage of income any person can be required to pay for insurance premiums in any given year. It goes from 9.5 percent for people at 300 percent of the poverty level—or 400 percent of the poverty level down to 2 percent for those between 100 to 133 percent. And that’s really important.
Now, can this be continued? Can we continue to hold these costs down? The answer to that is, I think, “yes, but only if we keep working together to cut unnecessary costs.”
A recent RAND Corporation study pegged unnecessary medical costs at a whopping $700 billion a year, about 30 percent of total spending.
How are we going to do this? Well, there are some impressive efforts already underway. The accountable care organizations, which are cropping up all over the country as a result of attempts to come to grips with health care reform, are basically proving it is possible to lower costs and improve care by basing reimbursements on the quality of health care outcomes, not on the number of procedures performed; competitive bidding for durable medical equipment; the reduction of medical errors that the rise in electronic medical records has spawned; new strategies to reduce readmissions to hospitals, including in-home care and community clinics. All these things are making a difference.
Bloodstream infections, one of the most common medical errors, are down 40 percent since 2008. Increased sterilization requirements, which is a high-toned way of saying you’ve got to wash your hands in more places in the hospital, are reducing infections all across America. In the past year, hospital readmissions under Medicare alone are down 70,000 people.
Also in the past year, finally, the national government began to publish comparative cost and outcome data. Pennsylvania has been doing this for years. I read the report every year.
Here’s what it shows in Pennsylvania: there is no relationship between what something costs and the outcome you get; that the closest correlation in— let’s just take surgical procedures. The closest correlation between good outcomes and a given procedure is not the price of it, but how many of those procedures are performed at a given place every year. And we now have years and years of data in Pennsylvania to support this.
Pennsylvania also has an interesting certified but long-standing accountable care organization called the Geisinger Medical Group, which has hundreds and hundreds of doctors which started years ago getting all of its doctors to agree, whatever their ages, to adhere to a set of best medical practices contained in a mammoth book that is upgraded weekly by the group of best medical practices for any kind of procedure.
And, essentially, it operates on the premise that medicine is both an art and a science. Let’s start with the science and then move to the art. That is, if, you know, you’re operating on somebody and they turn out to have a bad bleeding problem, you’ve got to deal with that, but first be like a pilot in an airplane and follow the checklist.
If, for any reason, anybody under their care is in a hospital and released, has to return to the hospital within either three or six months—I can’t remember which, I’m sorry—they pay 100 percent of the costs and your premiums, copays, and deductibles cannot be raised.
Guess what? Their medical errors have dropped to nearly zero, and their profits increased as a result. They didn’t make less money. They made more money because they had a fixed income for enrollment in the program.
Arkansas is also leading the way in doing that. This is really exciting to me, and you should be proud of this: getting all the payers in the health care system—they now have about 95 percent of them —employers, insurance companies, Medicaid, soon, the governor said this morning, to get Medicare to pay based on—we’ll just call it episodes—a flat rate, which basically works this way:
You do away with fee for service, and you reward performance. So if you get good results and you get them in a hurry, you’re going to make a lot more money. And if you get bad results slowly, you will probably lose money. But the incentives are designed to lower the costs while improving the quality.
And the reason it can be done, I believe, is because this is like what you did with the public health option. You got everybody in the room. You get all the employers, all the insurers, the Medicaid and Medicare folks, you’ve got a pretty broad spectrum economically, socially, and politically, and you just figure out how to make it work. I am very excited about this, and I think this state deserves a lot of credit for doing this as well.
Okay. So that’s where we are. So you can say to me, “Come on, Bill, there’s got to be something wrong with this. Anything that sounds too good to be true is.” This is pretty good.
So what are the known and potential problems, and what could still go wrong that hasn’t yet but could? Like any laws this complex, there are some problems that I think will have to be addressed.
First, the thing that bothers me the most— which I hope was just a drafting error—workers with modest incomes, like, say, 20 to $35,000 who work for a company that insures only them and not their family members, still are required by the law to provide for their families. And if their family is uninsured, they have to pay a penalty.
The problem is that under the law, because they have insurance at work, they can’t send their families into the Arkansas Exchange and get the tax credits. It’s obviously not fair, and it’s bad policy. But it’s not clear to me, based on what I can determine, that anybody intended this. If this is the only unintended consequence of the law, they did a pretty good job, but this has got to be fixed, and it’s just not fair. So I think Congress should fix it.
Secondly, small businesses with fewer than 50 people aren’t required to provide insurance, but a lot of them would like to. However, many of them have access to a tax credit, a different one, and many don’t.
This may surprise you. For example, if you have fewer than 50 employees, you can claim the tax credit for up to 25 of them. But if you have 35, you can claim the tax credit for 25 of them. If you have 43, you can claim the tax credit for 25 of them.
This is obviously just a budgetary decision, based on what the estimated insurance premiums would be and what the cost of the subsidies would be. But I believe that the current tax credit is too low. It sounds good. A 50 percent tax credit sounds like a lot. But if you read the fine print and how it’s calculated, there are relatively few companies eligible for the 50 percent tax credit, and then it begins, like, as the average wage goes up, the tax credit diminishes from 50 percent to something lower.
And what I think that Congress ought to do— and it ought to be possible to get bipartisan support for this—is to come in and basically make this tax credit available to more firms for more employees under the 50-employee limit and actually make it more generous to more firms so more will show up. There’s way more individuals wanting to sign up for this individual market than small businesses signing up for the small business market because the tax credit system just doesn’t work very well for small businesses now, and it needs to be improved.
Thirdly—and this is the third big problem, and it’s a whopper—this has to be fixed at the state level, where it isn’t being fixed. The Supreme Court ruling on the Affordable Health Care Act upheld the law, but said the states had the right to refuse to participate in taking the Medicaid expansion and money and to refuse to set up their own health exchange.
The law said—which was passed, obviously, before the Supreme Court reviewed it—that the federal government would run an exchange if the states didn’t. But they never dreamed that anybody would turn down the Medicaid money.
So, amazingly, about half the states have, comprising more than half the eligible people. Big states, like Texas, Florida, Ohio, and Pennsylvania, so far are rejecting the money. Michigan voted a couple of days ago to take it. They have a Republican governor and Republican legislature.
But here’s what’s going to happen: In those states, working people with incomes between 138 and 400 percent will be able to buy insurance on the exchange with subsidies, whether the exchange is run by the state or the federal government. But lower income working families with incomes at 138 percent or less, some of them even below 100 percent of the poverty line, are eligible for nothing.
So you get the worst of all worlds, where you’re saying, “I’m sorry but you’re working 40 hours a week, but you’re too poor to get help.” Not too rich, too poor. And this is a serious problem.
There’s also going to be a big jump in uncompensated care, especially in urban medical centers, like Houston, Miami, Cleveland, and Pittsburgh. These places have amazing medical centers, and they treat everybody. They do wonderful work. And they’re going to get hurt on this.
Their taxpayers’ money will be spent in other states, as Governor Beebe’s gas tax analogy reminds us. Their uncompensated care burdens will arise. That’s why Michigan, New Mexico, Nevada, Arizona, Iowa, New Jersey, and North Dakota, all with Republican governors and most with Republican legislatures, are taking the Medicaid expansion money.
Because of the Supreme Court decision, this is a problem that only the states can fix, so they’re going to have to think about this.
Now, we’ve also heard a lot of other things about potential problems in the law. Let’s go through some of them.
A lot of folks are worried that not enough healthy young people will sign up who are now uninsured. Why does that matter? Because if you let the relatively small number of people with severe preexisting conditions buy insurance at the same price as everybody else, that will run everybody else’s insurance policy up, unless you get a whole bunch of healthy young people to come in and at least buy those bronze policies, the limited policy, which will level out the risk pool for the insurance companies.
So that’s a legitimate—I mean, even though I’m however old I am, I still remember what it was like to be 27, when I was convinced I’d live forever and I’d never get a hangnail, much less have a serious accident. So there’s a lot of worry about this.
But a recent study by the Commonwealth Fund at least suggests that this may not happen. First, large number of young people age 26 and younger have already enrolled in their parents’ plans. And interestingly enough—if I were you guys, I’d promote this—the Republicans are a personal- responsibility party. There are more young Republicans enrolled in their families’ plans than young Democrats.
Second, the assumption that young people don’t buy insurance because they think they don’t need it isn’t backed up by the facts. Most young people surveyed said they did want insurance, but they didn’t earn enough to afford it.
The tax credits will allow a lot of them to afford at least one of the bronze plans. And I think if young people can afford the coverage, they should buy it and contribute to a well-funded system with lower rates, if for no other reason than they will not always be young. It’s both the right and the smart thing to do. Second, a lot of people are worried about the computer problems. I mean, think about it. You’re going to have all these state and federal computers up and running for the enrollment that opens October 1st and runs through the end of March. I think it’s remarkable what the state and federal officials have done to get the computer systems up and running.
Now, there may be glitches, but so far, there’s no evidence to suggest that they won’t be able to be fixed quickly. I have really been impressed just by what I’ve seen from what’s happening, both here and around the country.
Third, there are people who thought that because of the small business requirement or the requirement to cover all employees who work 30 hours a week or more, that there would be a lot of shifting of employees from full-time to part-time to avoid the 30-hour requirement for coverage. So far, it hasn’t happened.
Since 2010—listen to this. Since 2010, when the law passed, 90 percent of the employment gains in America have been in full-time jobs. In Massachusetts, where the law Governor Romney signed works a lot like the Affordable Care Act will work, there was no appreciable impact on job growth, the percentage of part-time workers, or employers dropping coverage.
So, so far, the direst predictions for the adverse consequences have not materialized, and I don’t believe they will.
Now, this law has already done a lot of good. It’s about to make 95 percent of us insured with access to affordable care. It has built-in incentives to lower costs and improve quality, including lots of opportunities for states to innovate, and Arkansas is Exhibit A. You should all be very proud of what your representatives and your governor have done.
We’ve got to do this because I will say again, the studies show that we are No. 1 by a country mile in the percentage of our income we devote to health care costs and rank no better than 25th to 33rd in the health care outcomes we get. This is the country that pioneered innovation in every other area of our national life. You cannot make me believe that we have to tolerate this from now until the end of eternity. I think we will become more competitive and healthier if we do this right.
Look what the RAND study says about Arkansas. It estimates that by 2016, Arkansas will have 400,000 more people with health insurance, 2,300 fewer deaths a year just in our state, a $550 million increase in GDP, spurred by a $430 million net increase in federal investment, leading to 6,200 new jobs.
For so long, so many have worked to remove barriers to quality affordable health care. Faith- based organizations, doctors’ groups, nurses’ groups, unions and businesses working together, patient advocates, they have all worked to insure that people had good solid coverage. And all these people have got a lot at stake here. They want to preserve what’s best in our system as we make the changes we need to make.
So here’s the bottom line to me. It seems to me that the benefits of reform can’t be fully realized, and the problems certainly can’t be solved, unless both the supporters and the opponents of the original legislation work together to implement it and address the issues that arise whenever you change a system this complex. There are always drafting errors, unintended consequences, unanticipated issues. We’re going to do better working together and learning together than we will trying over and over to repeal the law or rooting for reform to fail and refusing to fix relatively simple matters. I hope that Congress will follow the lead of the examples set by many, many Republicans and Democrats at the state level, and try to just do the best we can to implement this law, be up front and open about the problems that develop, and deal with them.
We all get paid to show up for work, and we need all hands on deck here. The health of our people, the security and stability of our families, and the strength of our economy are all riding on getting health care reform right and doing it well. That means we have to do it together.
Thank you very much.
Source: clintonfoundation.org
