Barack Obama - Health Care

Last Updated: Dec 15, 2010

Summary

While a State Senator from Illinois, Barack Obama stated that he supported a single-payer government run health care system. He also asserted that the US would not be accepting of such positions and that a change from the current system to a government system would take decades. These statements were used against him in the 2008 Presidential campaign by Senator Clinton and Senator McCain. Senator Obama responded to this criticism by amending the statements to claim that what he really meant was that while he preferred a single-payer system, it was not feasible given the system which was already present. President Obama also asserted during the Presidential debates that health care is a right that all people are entitled to and not a service which should be paid for by customers.

While campaigning for office, Senator Obama was an opponent of mandates which would simply require each person to purchase health insurance as a matter of law. He once mocked the idea of a mandate, and noted that if a mandate was a solution then we could simply mandate that everyone purchase a house and solve homelessness. Senator Obama opposed the idea of a mandate in debates, noting that it would sometimes cause people who could not afford insurance to pay a fine in addition to not having insurance. Despite this opposition, the 2009 health care reform legislation contained a mandate for individuals to purchase insurance with a penalty for those who do not comply. President Obama has asserted that such a fee is not a tax. When questioned on this statement and read the definition of a tax in comparison to the mandate fee, President Obama reiterated that the fine was not a tax even though the definitions matched.

President Obama has always been a strong supporter of a public option as a means to provide health insurance and decrease costs by providing competition for insurance companies. He was often critical of any reform bill that did not contain such a program. However, the public option that the President endorsed was not a true public option that simply allowed the government to operate an insurance company at cost. The program put forth by the President granted government subsidies for those unable to pay to use for their insurance premiums. The plan proposed by President Obama allows the government to run an insurance company, grants funds to people in the form of subsidies, and then collects those funds in the form of premiums.

During the 2008 Presidential Campaign, Senator Obama outlined a plan that consisted of methods to lower health care costs and extend coverage to everyone. The plan consisted of preventing companies from using pre-existing conditions to turn away customers, coverage for all "essential services", and the previously noted subsidies.

Coverage options for all Americans
- Nobody turned away for pre-existing conditions
- Everyone able to buy plan similar to all federal employees
- Covers all essential medical services
- subsidy provided to those who can't afford
- Portable coverage
- No longer lines
- Private plan options available
Lower Costs
- Help to small business
- Tax credits to cover up to 50% of employee insurance
- Take on big drug companies blocking reform
- Cut costs for small businesses and workers by:
  - Picking up part of tab on most expensive illnesses
  - Allow insurance purchase in low risk pool
- Lower family health care costs by
  - investing in prevention
  - Investing in paperless system to cut admin costs

After elected, President Obama asserted that his plan consisted of three components: the rising cost of health care must be brought down, Americans must have the freedom to keep their doctor and health care plan if they chose to do so all Americans must have quality, affordable health care.

During the 2009 health care debate, two of the chief points of opposition were the claim that the reform plans would pay for abortion and provide health care for illegal aliens. This led to a stand off with pro-life House Democrats over abortion and the infamous "you lie" moment during President Obama's address on Health care. President Obama repeatedly asserted that no funding was provided for abortions in the health care reform bill. The plan put forth by President Obama would provide government subsidies to those who could not pay their premiums, and allow them to purchase plans that covered abortions with those subsidies. The second point of contention was wether or not illegal aliens were provided coverage under the plan. President Obama asserted that the bill expressly prohibited allowing illegal aliens to purchase health insurance through his exchange. Opponents noted that there was neither a mechanism to check a person's residency status, nor a mechanism to punish illegal aliens who received such health care.

In speeches and debates during the election, Senator Obama openly mocked Senator McCain's proposal to tax "cadillac" health care plans. He stated that Senator McCain could make no pledge not to raise taxes since he was proposing this tax. President Obama has supported such a tax and stated that cadillac plans just take more money from people without making them more healthy.

One of the more notable promises made by Senator and President Obama was that all negotiations would take place on CSPAN. He stated that health care companies would still have a seat at the table, but would not be able to buy all the seats. He made these promises after the election as well. No effort was made to accomplish this task by President Obama.

Throughout the health care reform process, President Obama was adamant that the end product would reduce the overall cost of health care, and be budget neutral for the first ten years of the program. Part of his campaign literature states that the reform will be paid for through ending the Bush tax cuts for those making over $250,000 and retaining the estate tax at 2009 levels. As the legislation passed, President Obama stated that it would reduce the federal deficit by $1.3 trillion over the next two decades, making it the greatest deficit reduction tool since the balanced budgets of the 1990's.

President Obama supported the use of reconciliation as a means to pass health care reform. When asked about the subject, President Obama asserted that the American people were interested in health care reform and not the legislative mechanisms used to implement the reform. President Obama has been and remains a consistent supporter of the 2009-2010 health care reform.

Since assuming office, President Obama has appointed Donald Berwick to be the head of Medicare and Medicaid, a position otherwise known as the health care czar. Mr Berwick has shown a great deal of support for single-payer systems and the redistribution of wealth through health care.

Universal Health Care

Early in his career, State Senator Obama and US Senator Obama supported a universal health care plan for the US. At a 2003 AFL-CIO speech, (State Senator) Obama can be heard stating the following:

... which is "How do we get the federal government to take care of it's business?" I happen to be a proponent of a single-payer universal health care plan. And I see no reason why the United States of America, the wealthiest country in the history of the world is spending 14 percent, 14 percent of its gross national product on health care, cannot provide basic health care insurance to everybody. That's what Jim's talking about when he says "Everybody in, nobody out"; a single payer health care plan, universal health care, and that's what I would like to see. But as all of you know, we may not get there immediately, because first we've got to take back the white house, and we've got to take back the Senate, and we've got to take back the house.

This video was used by the Clinton campaign to accuse Senator Obama of being misleading when he made later attempts to claim that he was not supportive of such a plan. When asked about the situation in a CNN primary debate, Senator Obama stated the following:

I never said that we should try to go ahead and get single-payer, what I said was that if I was starting from scratch ... If we didn't have a system in which employers have typically provided health care, I would probably go with a single payer system.

Senator Obama was pressed again on the matter days later on the Today show. When he was played the audio from 2003, he claimed not be able to hear it and that the statement may have been taken out of context.

Today Show: ... The Clinton campaign has released a web video of you advocating for a single payer health care system back in 2003, and they've sliced that together with what you said at Monday night's debate. Watch that first and then we'll talk on the other side of it.

Video : Obama in 2008: I never said that we should try to go ahead and get single-payer

Video : Obama in 2003: I happen to be a proponent of a single-payer, universal health care plan

Today Show: Where's the consistency Senator Obama?

Obama: I'm sorry, Meredith, I confess that I couldn't hear very well there so. (Talking over each other) What I said in the debate was that a single payer system is one that I would support if we were starting from scratch. I can't tell from that clip how ... It didn't sound like it was very long so it may not have had the full context of my remarks.

(Talking over each other)

What i've said consistently is that if we didn't have a legacy of employer based health care then it might make more sense to set up a single payer system. I've always said that, I said that during the course of this campaign. But what i've also said is that we've got to build on the system that we've got and immediately provide health care for people who need it, and trying to make sure that everyone has access to a health care plan that is at least as good as the health care plan that I have as a member of congress. That's something that i've been consistent about throughout this campaign and it's something that I will fight for when I am President of the United States.

Several other times after the debate, Senator Obama was asked again about why he changed his position and he re-iterated that a single-payer system was preferable when there was no other system in place, but there was a need to act quickly and build on the system in place.

Health Care is a Right

As part of the general election debates, Senators Obama and McCain were asked if health care was a right or a privilege. Senator Obama responded that health care is a right and that no one should go broke because they had to pay their health care bills.

Health care mandates

Throughout the campaign, Senator Obama was an opponent of health care mandates and often noted that mandates alone do not solve the problem. He often used this issue in debates to draw contrasts between Senator Clinton and himself. In one of the January 2008 primary election debates with Senator Clinton, Senator Obama said the following:

... Senator Clinton has a different approach. She believes that we have to force people who don't have health insurance to buy it. Otherwise there will be a lot of people who don't get it. I don't see those folks and I think that it is important for us to recognize that if in fact you are going to mandate the purchase of insurance and it is not affordable, then there's gonna have to be some enforcement mechanism that the government uses and they may charge people who already don't have health care fines, or have to take it out of their paycheck and that I don't think is helping those who don't have health insurance, that is a genuine difference (between Obama and Clinton).

In a CNN debate, Senator Obama again drew this distinction between himself and Senator Clinton.

Understand that when Senator Clinton says a "mandate" it's not a mandate on government to provide health insurance, it's a mandate on individuals to purchase it, and Senator Clinton is right. We have to find out what works. Now Massachusetts has a mandate right now, and they have exempted 20% of the uninsured because they've concluded that that 20% can't afford it. In some cases, there are people who are paying fines and still can't afford it so now they are worse off than they were. They don't have health insurance, and they're paying a fine. In order for you to force people to get health insurance, you've got to have a very harsh stiff penalty, and Senator Clinton has said that we won't go after their wages. Now, this is a substantive difference, but understand that both of us seek to get universal health care, I have a substantive difference with Senator Clinton on how to get there.

In a later interview on CNN, Senator Obama stated that mandates were not the solution and if they were, we could simply mandate that all the homeless purchase a house.

If a mandate was the solution, we could try that to solve homelessness by mandating that everybody buy a house. The reason they don't have a house is that they don't have the money. So our focus has been on reducing costs, making it available. I am confident that if people have a chance to buy high quality health care that is affordable, they will do so and that's what our plan does.

President Obama mirrored this language once in office. After if became clear that a mandate to purchase insurance would be part of the health care reform bill, questions were raised about whether or not this violated not only President Obama's opposition to a mandate, but also his promise not to raise taxes. Was a mandate to purchase health insurance under threat of punishment equivalent to a tax increase? This lead to the following conversation in an interview with George Stephanopoulos.

Stephanopoulus: You were against the individual mandate during the campaign. Under this mandate, the government is forcing people to spend money, (and) fining you if you don't. How is that not a tax?

Obama: Well hold on a second George, Here's what's happening. You and I are both paying $900 bucks on average ... on average ... our families ... in higher premiums because of uncompensated care. Now what I've said is that if you can't afford health insurance, you certainly shouldn't be punished for that, that's just piling on. If on the other hand we're giving tax credits, we've set up an exchange, you are now part of a big pool, we've driven down the costs, we've done everything we can, and you actually can afford health insurance, but you've just decided, "You know what, I just want to take my chances." And then you get hit by a bus, and you and I have to pay for the emergency care.

Stephanopoulus: That may be, but it is still a tax increase

Obama: No, that's not true George. For us to say that you've got to take responsibility to get health insurance is absolutely not a tax increase, what it's saying is that we're not gonna have other people carrying your burdens for you, anymore than the fact that right now, everybody in America, just about, has to get auto insurance. Nobody considers that a tax increase. People say to themselves "That is a fair way to make sure that if you hit my car, then i'm not covering all the costs.

Stephanopoulus: Well, it may be fair, it may be good public policy ...

Obama: But George, you can't just make up that language and decide that that's called a tax increase. If I say that right now, your premiums are going to be going up by 5 or 8 or 10 percent next year, and you say "Well that's not a tax increase," but on the other hand if I say that I don't want to have to pay for you not carrying coverage even after I give you tax credits that make it affordable ...

Stephanopoulus: I don't think that I am making it up, Merriam Websters dictionary ... Tax - a charge, usually of money imposed by authority on persons or property for public purposes.

Obama: George, the fact that you looked up Merriams dictionary, the definition of tax increase, indicates to me that you're stretching a little bit right now. Otherwise you wouldn't have gone to dictionary to check on the definition.

Stephanopoulus: Well no .. I wanted to check for myself, but your critics say it is a tax increase

Obama: My critics say everything is a tax increase. My critics say that i'm taking over every sector of the economy. You know that. Look, we can have a legitimate debate over whether we're gonna have an individual mandate or not ...

Stephanopoulus: But you reject that notion, that it's a tax increase.

Obama: I absolutely reject that notion

The Public Option

A public option is little more than an insurance company that is run by the federal government. The idea is that such a system operates just at the break even point and forces private insurance companies to lower their costs to compete. Throughout the campaign, and even after the election in 2008, President Obama was an ardent supporter of the public option. Several times in the campaign, and even after the election, President Obama stated that any health care reform must include a public option. When the health care reform plan that was signed into law did not have a public option, proponents of the system on the left were very critical of President Obama. The commercial below was made in an attempt to get the President to reconsider the public option and show his pledge after becoming president to include the system.

Any plan I sign must include an insurance exchange, including a public option to increase competition and keep insurance companies honest

Health Care as a Commodity

In a Presidential debate, Senator Obama reiterated that anyone who likes their health care can keep it. He also claimed that health care was a moral and economic imperative. He was critical of Senator McCain's plan to tax health care as a commodity.

Campaign Website Plan

The plan that President Obama put forth during the 2008 campaign and after the election, included subsidies for those who could not afford the insurance, a law making it illegal for an insurance company to refuse someone due to a pre-existing condition, and the ability to take the coverage from job to job. These items are covered in the President's "blueprint" for health care and in statements made on his campaign website.

Blueprint for Healthcare

During the 2008 presidential election, Senator Obama made a series of videos called blueprints for a variety of subject. The blueprint for healthcare is shown here.

Coverage options for all Americans
- Nobody turned away for pre-existing conditions
- Everyone able to buy plan similar to all federal employees
- Covers all essential medical services
- subsidy provided to those who can't afford
- Portable coverage
- No longer lines
- Private plan options available
Lower Costs
- Help to small business
- Tax credits to cover up to 50% of employee insurance
- Take on big drug companies blocking reform
- Cut costs for small businesses and workers by:
  - Picking up part of tab on most expensive illnesses
  - Allow insurance purchase in low risk pool
- Lower family health care costs by
  - investing in prevention
  - Investing in paperless system to cut admin costs

My plan begins by covering all Americans. If you already have health insurance, the only thing that will change for you under this plan is the amount of money that you will spend on premiums. That will be less than what you are spending now. But if you are one of the 45 million Americans who don't have health insurance, you will have health insurance that is available to you. No one will be turned away because of a pre-existing condition or illness. Everyone will be able to buy into a new health insurance plan that is similar to the one that every federal employee, from a postal worker in Iowa, to a congressman in Washington currently has for themselves. It will cover all essential medical services, including: preventative, maternity, disease management, and mental health care. And will also include high standards for quality and efficiency. If you can't afford this insurance, you'll receive a subsidy to pay for it. If you change jobs, your insurance will go with you. If you need to see a doctor, you will not have to wait in long lines for one. If you want more choices, you will also have the option of purchasing a number of affordable private plans that have similar benefits and standards for quality and efficiency.

And my plan also provides substantial help to small businesses, to cover their employees. Small businesses are America's biggest job creator. Since 1990, companies with fewer than 20 employees have created 80 percent of new jobs in America. But today, too many small businesses are sinking under the weight of rising health care costs. My health care plan won't impose a single new burden on small businesses. Instead, we'll give them tax credits that will cover up to 50% of the cost of insuring their employees. This will help them create not just new jobs, but good jobs, jobs with health care, that stay right here in the United States of America.

We will take on the big drug companies and insurance companies that have been blocking reform for so long, and provide affordable quality healthcare for all. Cut costs for small businesses and their workers by picking up part of the tab for some of the most expensive illnesses, and allow small business to purchase insurance in a new low risk pool. And we'll cut the cost of a typical families health care by up to $2500 dollars per year by investing in prevention, and stopping diseases before they get so bad that they're expensive to treat. By investing in a paperless system to cut administrative costs. That's the commitment that I am making to you the American people, and that's the plan that i'll sign into law by the end of my first term as President of the United States of America.

2008 Campaign Website Statements

The Obama-Biden Plan

On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options.

Make Health Insurance Work for People and Businesses -- Not Just Insurance and Drug Companies.

Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.

Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.

Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.

Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.

Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees' health care.

Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.

Ensure everyone who needs it will receive a tax credit for their premiums.

Reduce Costs and Save a Typical American Family up to $2,500 as reforms phase in:

Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.

Require hospitals to collect and report health care cost and quality data.

Reduce the costs of catastrophic illnesses for employers and their employees.

Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

The Obama-Biden plan will promote public health. It will require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.

A Commitment to Fiscal Responsibility:

Barack Obama will pay for his $50 - $65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.

Three Principles for Health Care Reform

In the 2008 election cycle, after the election, and during the 2009 to 2010 reform debate, President Obama responded repeatedly to fears that any health care reform would force those who like their coverage to switch to another plan by stating that if you like you health care, then nothing will change. He stated that "if you like your health care coverage, keep it." The video below shows a section of debate where Senator Obama outlines his plans and asserts this claim.

After assuming office, President Obama remained assertive of this principle and further refined his views by stating that any reform must remain committed to three principles:

the rising cost of health care must be brought down
Americans must have the freedom to keep their doctor and health care plan if they chose to do so
all Americans must have quality, affordable health care

Health Care Rallies

In the Summer of 2009, President Obama held a series of rallies throughout the country which attempted to galvanize support for the reform being proposed in Congress.

Costs of Health Care Reform

In June of 2009, President Obama used his weekly address to discuss the costs of health care reform. He stated that any reform must be budget neutral over the next ten years. He noted that in addition to other measures, there would be an addition $313 Billion dollar cut to Medicare and Medicaid programs.

Myths and Morality

On August 21, 2009 President Obama used his weekly address to address the myths and morality of health care reform. In this address, President Obama stated that the reform packaged in Congress did not constitute a government takeover of health care, that there were no "death panels", and that anyone who liked their health care would be able to keep it. He also stated that coverage for abortions would not be provided, and that illegal aliens would not be covered under the plan. He also reiterated the core promises of his campaign that prices would be lowered and coverage extended to all.

Cadillac Health Care Plans

The term "cadillac" is used to describe health care plans that cover a large number of procedures at a high reimbursement rate. In other words, plans that may cost a lot but provide a great deal of coverage. During the 2008 Presidential campaign, Senator Obama was critical of Senator McCain's plans to tax those plans to help pay for the costs of health care for others. In Newport News, Virginia on October 4, 2008, Senator Obama said the following at a campaign rally.

John McCain calls these plans "cadillac plans". Now, in some cases it may be that a corporate CEO is getting too good a deal. But what if you're a line worker making a good American car like the cadillac? What if you're one of the steel workers who are working right here, in Newport News, and you've given up wage increases in exchange for better health care? Well, Senator McCain believes that you should pay higher taxes too. The bottom line ... the better your health care plan, the harder you fought for your good benefits, the higher the taxes you'll pay under John McCain's plan.

These statements reenforced some made on September 12, 2008 in Dover, New Hampshire. In these statements, Senator Obama noted a pledge he had made not to increase taxes on anyone making less than $250,000. He stated that Senator McCain could not make this pledge as he would tax cadillac plans.

I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes. And my opponent can't make that pledge and here's why: For the first time in American history, John McCain wants to tax you health care benefits. Apparently Senator McCain doesn't think that it's enough that health care premiums have doubled, he thinks that you should pay taxes on them too. That's a $3.6 trillion dollar tax increase potentially on middle class families.

These pledges directly contradict statements made by President Obama since taking office, and the contents of the 2009-2010 health care reform legislation that contains these provisions. On December 23, 2009 President Obama was interviewed by NPR and stated that he was "on record" as supporting the taxing of cadillac health care plans.

Q: The House wants to tax wealthy individuals, the House wants to tax health care providers of these very generous health care plans .. the so-called "cadillac" tax. Which of those would you rather see in a final bill?

Obama: I think that what we're gonna end up seeing is a little bit of both. We're gonna have some provisions that are smart, that are in the House bill, there are gonna be some provisions that are the right thing to do in the Senate bill. For example, I am on record as saying that taxing cadillac plans that don't make people healthier, but just take more money out of their pockets because they're paying more for insurance than they need to ... that's actually a good idea.

CSPAN Access to the Process

During the 2008 campaign and after the election, Senator and President Obama repeatedly stated that the health care negotiations would be broadcast on CSPAN. No effort was made to accomplish this task.

Health Care Address

On September 9, 2009 President Obama gave a speech before a joint session of Congress to express his support for health care reform. During this address, President Obama asserted that the proposals in Congress did not provide health care for illegal aliens. At this time, Congressman Joe Wilson shouted "You Lie" from the crowd.

On Reconciliation

After the passing of Senator Kennedy and the election of Senator Brown in Massachusetts, the Democrats no longer possessed a 60 vote supermajority in the Senate. At this time, discussion began on passing a reconciliation bill which would require only 50 votes and combine the two previous health care reform versions passed in the House and Senate. The reconciliation technique is typically used only for adjusting funding levels to align two versions of legislation. When asked about the possibility, President Obama stated that he did not believe that the American people cared about the process used to implement the reform, only the reform itself.

Reform Reduces the Deficit

In March of 2010, as the final vote on the reconciliation bill was approaching, President Obama announced that an analysis from the CBO would reduce the deficit by $1.3 trillion over the next two decades. He stated that it was the most significant effort to reduce deficits since the balanced budget amendment of the 1990s.

On the Passage of Health Care Reform

In March of 2010, after the passage of the health care reform legislation in Congress, President Obama gave an address noting the historic moment and his support for the legislation.

Appointment of Health Care Czar

Voting Record

Amendment - Drug Reimportation

In July of 2006, a an amendment was voted on to prohibit the United States Customs and Border Protection from preventing an individual not in the business of importing a prescription drug from importing an FDA-approved prescription drug. Barack Obama voted in favor of the amendment to prevent border patrol agents from taking prescription drugs from citizens crossing the border.

Barack Obama voted in favor of the amendment to prevent border patrol agents from taking prescription drugs from citizens crossing the border.