Almost a year to the day after his argument for the re-election of President Barack Obama at the Democratic Convention, President Bill Clinton today made the pitch for the president’s healthcare reform law. Enrollment into health coverage for millions of Americans begins in less than a month under Obamacare, a law that continues to inspire fierce opposition. Today’s speech, given at the Clinton Library this morning, wasn’t the home run the former president delivered a year ago, but it was a solid (if a bit drowsy) performance in classic Clintonian fashion, deliberately outlining the policy stakes in healthcare — where we’ve been, what’s changing, where we’re going, and why it matters. 

“I have agreed to give this talk today because I’m still amazed at how much misunderstanding there is about the current system of healthcare…and what changes are actually occurring ,” Clinton said. He listed the problems with the healthcare system prior to the law, the various folks that have benefited from the law already, and the various folks that stand to benefit in the future, all of which will be familiar territory to readers of this blog (or Ernie Dumas). These are important facts to state and re-state, but there is no “explainer in chief” magic wand to wave. Obamacare resistance, obviously, will live on (40 repeal votes in the House and counting!).


The theme of Clinton’s speech, though (and this is also very Clintonian), was really an appeal to those who opposed the law.

“We’ll all be a lot better off, whether we support or oppose the healthcare reform law, whether we like it or don’t, we’d all be better off working together,” he said. “Working together to make it work as well as possible, to identify the problems and to fix them, instead of keep replaying the same old battles.”


And you’re never going to believe this, but Clinton had a list of reasons why. Six of them:

1) “It’s better than the current system, which is unaffordable and downright unhealthy for millions of Americans.”
2) “It gives states the chance to devise programs that work best for them and their populations.”
3) “Not cooperating means states’ taxpayers will pay for this and the money will go to somebody else somewhere else.” (This was Gov. Mike Beebe’s frequent line during the Medicaid expansion debate.)
4) “The problems with the law — you can’t change a complex eco-structure like the American health care this much without creating some problems — they can best be solved if we all work together to fix them.”
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.”
6) “It is the law. We’ve all got an interest in trying to faithfully execute the law.”

Clinton’s not the first person to make this point, but #4 is worth highlighting. “Like any law that’s this complex there are some problems that I think will have to be addressed,” he said.


Clinton outlined a few: He noted a glitch that could preclude family members of an employee from getting subsidies even if the employee’s family coverage was unaffordable. He suggested that small businesses should get more generous tax credits to provide insurance for their employees. And he harped on the “hole in coverage,” an issue we’ve covered a great deal: in states that refuse to expand Medicaid, people with moderate incomes above the poverty line will get subsidies while poorer people below the poverty line will be left out in the cold. (Though the “fix” here isn’t a change in the law, it’s for states to go forward with expansion).

Others, of course, will have their own list. There will inevitably be, as Clinton said, “drafting errors, unintended consequences, unanticipated issues.” As the law goes into effect there will be the need for tweaks. Maybe the subsidies, or the penalties, are too high or too low. Maybe the system of community rating could be improved, or the rules around essential health benefits. The problem is that even a change to the law that Republicans should love is dead in the water because anything other than full-on repeal is considered a surrender to Obamacare. 

Despite those 40 repeal votes, Obamacare is still here. It’s likely to be here for a while. But that doesn’t mean health care reform is over. There is plenty of work to be done and plenty of debates to be had about the best way forward. There are, as Clinton pointed out, fixes and tweaks and improvements to be made. But it’s awfully hard to have those debates and to seek the best policy outcomes if the mere thought of improving the law is verboten. Full trainwreck ahead! 

When I’ve spoken with Republicans about this, they usually bring up a political calculation. Step one, trainwreck. Step two, electoral gain! Maybe. But I think, at least in policy terms, they’re making a strategic mistake if they refuse to engage. Unless the national political climate changes radically, Republicans who say “repeal or nothing” aren’t going to get a thing. Obamacare isn’t, or shouldn’t be, set in stone as written. There will, or should be, fixes. Conservatives willing to negotiate will have a chance to shape those fixes.


There is no contradiction in seeking to make a law work as well as possible, even if one opposes the law. Moreover, these policy decisions have impacts on people’s lives. Insofar as lawmakers aim to make a law work less well, they are in fact aiming to cause harm to the people the law affects. 

It was apt, then, that Clinton made this pitch in Arkansas, for reasons beyond the home turf. Clinton gave praise to the state’s so-called “private option” for Medicaid expansion. That came about in large part because a group of Republicans fiercely opposed to Obamacare recognized that the law was coming whether they liked it or not, and sought what they believed to be the best outcome for the state. They didn’t like the law as written, so they pushed for tweaks (they would say “fundamental reforms,” but you get the drift). Instead of a middle-finger approach, they came to the table. 

I’ll shut up now, and turn it over to the “Explainer in Chief”:

The bottom line to me is that the benefits of reform can’t be fully realized and the problems certainly can’t be solved unless both the supporters and opponents of the original legislation work together to implement it and address the issues that arise whenever you change a system this complicated…. We’re going to do better working together and learning together than [symbolic votes to] repeal the law or rooting for it to fail and refusing to fix relatively simple matters. I hope the Congress will follow the lead of the example set by many Republicans and Democrats at the state level and try to do the best we can to implement this law. Be upfront 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. 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.