Echoing the arguments of some journalists, he attributed the lack of public awareness of the historic gains in coverage to a negativity bias among members of the media and an impulse to place all of the burdens of health-care dysfunction at the feet of his law. Coverage of concepts like health-insurance premium increases—which have risen, sometimes unevenly for some groups of people—has been flawed by a failure to mark the rate of increase, which Obama points out is the lowest in 50 years nationwide.
No matter how much of the continued ambivalence about Obamacare is based on a misunderstanding or negativity bias among the media, it is undoubtedly true that the law hasn’t met many of its own benchmarks, nor the expectations of many of its supporters. As the Clinton campaign and other Democrats on the campaign trail have found, calls to reform the law work better than playing defense, and Obama’s speech turned to that reform work after a victory lap. He mentioned the enduring problem of lack of enthusiasm and sign-ups among young people, an issue that has bedeviled Obamacare for years now; market instability in some areas after major insurers exited exchanges this year; and the continued inability of many families to afford health insurance and health care.
For Obama, the path to fixing those problems is not necessarily through drastic change, but rather through tinkering. Notably, three of his most substantial solutions—all states expanding Medicaid to low-income people, promoting state innovation with insurance and delivery systems, and providing an emergency public health-insurance option in places where insurers pull out of markets—are all restorations of original policy points in the Affordable Care Act that have been whittled away via political or legal decisions. The new reform idea that the president presented Thursday is using the system’s savings to offer more tax credits to young people and families to help them afford insurance on an exchange. That the most radical change to the original framework of Obamacare that he’s pitching is an increase in tax credits is indicative of Obama’s faith in the long-term outcomes of health reform. And he presents a reform vision that is much more modest than even Hillary Clinton’s moderate proposals for a Medicare extension to near-elderly adults and the creation of a public option.
The general Republican strategy of “repealing and replacing” Obamacare has had remarkable staying power even as uninsured rates have plummeted, perhaps reflecting public ambivalence about the law. Obama’s speech took jabs at would-be repealers using a timely quip about replacing Samsung smartphones with rotary phones, but his overall sentiment seemed to be that the endurance of calls to repeal Obamacare is tied as much to him as it is to the actual policy. His speech appeared to concern his legacy: Will politicians be able to make the necessary fixes to the ACA once he leaves office?