Former President Bill Clinton used the forum of his Presidential Library to advocate for the Affordable Care Act, which hits a major milestone on Oct. 1 when health insurance exchanges open a new online marketplace.

Introduced by Mara D’Amico, a Clinton School student who revealed she has a pre-existing condition – Type I diabetes – she also noted that she would be losing her parents’ health insurance coverage when she turns 27 years old later this year.  No penalties for pre-existing conditions and extended student coverage are two key provisions of the health care law.

Clinton said that he has had an active interest in health care improvement since the days of his first elected office as Arkansas Attorney General. Clinton said studying the issue of Medicaid fraud in nursing homes as AG sparked his initial interest in the subject.

As Arkansas Governor, he noted that seeing rural communities with “virtually no access” to health care also encouraged him to push for changes to the health care system.

“I’ve been involved in this subject for a long time,” said Clinton, who failed to achieve a massive national overhaul during his two terms as President.

FOLLOWING THE FEDERAL LAW
Clinton spent his speech at the Clinton Center chronicling the positives and negatives of the current federal law, the Affordable Care Act. He also promoted Arkansas’ “private option” plan and, in prepared remarks, recited the mechanics of how citizens can access the forthcoming options in Arkansas.

“I’m still amazed at how much misunderstanding there is about our current system of health care,” Clinton said. “We’d be better off working together to make the health care law work rather than fighting the same old battles.”

Clinton cited 6 reasons why the Affordable Care Act should be followed and possibly improved:

  • It’s better than the current system;
  • It gives states a chance to provide plans that work locally;
  • Not cooperating means states’ funds will go elsewhere;
  • The problems with the current law can be solved;
  • It gives the best chance ever for universal coverage, lower costs; and
  • It is the law

“We’ve all got an interest in trying to faithfully execute the law,” Clinton said.

Clinton argued that lowering health care’s percentage of GDP from its current point of 18% to 12% – which would be in line with other advanced countries – would inject $1 trillion back into the American economy.

“That’s money that could be spent on pay raises or investments in businesses,” he said.

WHAT COULD GO WRONG?
Clinton discussed problems he sees in the federal law and called on a bipartisan approach to fixing them.

He noted that workers with modest incomes – in the $20,000 to $30,000 range – may be eligible for health insurance through their employers, but their families may not qualify. Subsequently, because a household income may be too high to qualify for low-income help, Clinton said spouses and children may not be eligible for coverage.

“It’s obviously not fair,” said Clinton. “If this is the only unintended consequence of the law, it needs to be fixed.”

Clinton also said tax credits for businesses need to be expanded and more generous. He noted that a small business with fewer than 50 full-time workers isn’t required to provide health insurance. If more tax credits were designed properly and provided, those smaller firms could also be inclined to join the health insurance pools.

Thirdly, Clinton said that the U.S. Supreme Court decision to allow states to opt in or out of Medicaid expansion participation needs a solution.

“The law said that the federal government would run an exchange if states didn’t,” he said. “But they never dreamed anyone would turn down the Medicaid money.”

About half of the states have opted not to receive Medicaid expansion funds. Clinton said this means low income workers below 138% of the federal poverty level may not qualify for any health insurance options.

“This is a serious problem,” Clinton said adding that it would increase uncompensated care.

In his closing remarks, Clinton called for a bipartisan approach to solving the issues he outlined. He said there was no room for those “rooting for reform to fail and refusing to fix relatively simple matters.”

He cited the Arkansas legislature’s “private option” approach as a blueprint for federal fixes.

“I hope Congress will follow the lead of many, many Republicans and Democrats at the state level and try to implement this law,” said Clinton. “The health of our people, the security of our families, and the strength of our economy are dependent on getting health care right.”

POLITICAL PINATA
The federal health care law has been a political pinata in Arkansas. Republicans have made it a central focus in campaigns at the local, state and national levels and opposition to Obamacare has helped them score major gains.

Since 2010, the GOP has picked up county government and state constitutional seats, reversed the Congressional delegation from a 5-1 deficit to a 5-1 advantage, and earned a majority in both chambers of the Arkansas legislature for the first time since Reconstruction.

In the 2014 elections, health care promises to be another central campaign theme. Sen. Mark Pryor (D) has stood by his vote for the federal law and enumerated reasons why it is working and should be improved. His opponent, Cong. Tom Cotton (R ), has called for a full-scale repeal of Obamacare.

In the Governor’s race, Democrat Mike Ross has gone to great lengths to distance himself on the issue, claiming he is the only candidate who “voted against Obamacare.” Republicans contend a 2009 vote he cast in a House committee could have halted the law, but there were more than enough votes with or without Ross’ vote for the measure to move to the full House. It was ultimately not the bill voted on by House members.

Arkansas lawmakers have also struggled with the health law’s implementation. Democrats joined a split faction of Republicans in supporting the “private option,” a GOP-crafted plan that allows the Medicaid expansion dollars from the Affordable Care Act to be used in a private health insurance exchange for low-income workers. Details of the exchange, including crucial pricing options for health plans, are expected to be revealed next week by Arkansas insurance officials.

The private option is likely to be a contentious issue in Republican primaries next spring, and it is certain to be a major campaign debate among state, legislative, and federal races in the 2014 general election.