Looking Back at Health in SOTU

When President Obama took to the podium for last year’s State of the Union address, he faced Congress with a federal exchange website that had just barely started working. This year, he will address Congress from a much stronger position when it comes to the Affordable Care Act, with the uninsured rate at historic lows and the federal exchange working for most consumers.

Despite that improvement, the president faces still faces a challenge in his first fully Republican Congress. And the ACA is not out of the woods yet, thanks to a second serious Supreme Court challenge this spring. To see how different (or similar) things might be from 2014 to 2015, we are taking look back at what the president said on health policy in the last SOTU.

1)  The Republican Replacement Plan

“Now, I don’t expect to convince my Republican friends on the merits of this law.  But I know that the American people aren’t interested in refighting old battles.  So again, if you have specific plans to cut costs, cover more people, and increase choice – tell America what you’d do differently.”

This is a line the president could repeat verbatim this year. Republicans did not outline a major Affordable Care Act replacement plan in 2014, something that wasn’t much of a surprise given the midterm elections. Although the House and Senate are now both held by Republicans, it seems unlikely the GOP could coalesce around a single plan, or that they would even want to do that ahead of the 2016 presidential election. In the meantime, the “what you’d do differently” for Republicans has and will likely remain repealing pieces of Obamacare. The first change the Republican Congress is after would redefine a full-time employee as someone who works 40 hours per week, to free up some businesses from falling under the law’s requirement to offer health insurance or pay a fine. The president issued a veto threat on that bill.

2) Health Care Costs Carousel 

“For decades, few things exposed hard-working families to economic hardship more than a broken health care system.  And in case you haven’t heard, we’re in the process of fixing that.”

President Obama can claim a partial victory on this front, as the uninsured rate fell 26 percent last year, according to HHS. In addition, according to a Commonwealth Fund survey, 35 percent of consumers had trouble with a medical bill or medical debt in 2014, down from 41 percent in 2012. But Republicans would contend then and now that Obamacare has caused private health insurance premiums to increase as the federal government has placed new restrictions on exactly what has to be offered in those plans.

3) Enrollment Number Ups and Downs

“Already, because of the Affordable Care Act, more than three million Americans under age 26 have gained coverage under their parents’ plans. More than nine million Americans have signed up for private health insurance or Medicaid coverage.”

HHS officials had to backtrack some of those enrollment numbers, after they mistakenly added nearly 400,000 dental insurance enrollees to medical ones in their report. It brought the enrollment total down from 7 million to 6.3 million. Between 8 and 11 million people gained insurance in the last year, according to an HHS report.

4) Medicare Math

“We did all this while adding years to Medicare’s finances, keeping Medicare premiums flat, and lowering prescription costs for millions of seniors.”

Obama can go back to using this line again as well. The Congressional Budget Office in July reduced projected federal health spending for Medicare by 15 percent, and HHS in October announced premiums and deductibles for Medicare Part B would be unchanged from 2014 to 2015, staying at $104.90. The agency announced in July 8.2 million seniors and people with disabilities saved an average of $1,407 on prescription drugs since 2010 through ACA rebates and discounts. But just how much credit Obama and the ACA can take for the slower-than-normal rate of health care costs, particularly in Medicare, is still up for economists to debate.

5) Medicaid’s Bipartisan Bright Spot

“And if you want to know the real impact this law is having, just talk to Governor Steve Beshear of Kentucky, who’s here tonight.  Kentucky’s not the most liberal part of the country, but he’s like a man possessed when it comes to covering his commonwealth’s families.”

This time around, Obama could spotlight the Republican governors have embraced additional federal funds to expand their Medicaid programs. Wyoming, Tennessee and Utah, all under Republican governors, are currently exploring how to expand Medicaid in their states. Meanwhile, other Republican-led states like Indiana and Arkansas, are getting creative with how they implement their Medicaid expansion.