Health Care and the State of the Union: Obama Eager to Improve Law, Not Kill It

In his State of the Union address Tuesday night, President Barack Obama didn't shy away from tackling the ongoing questions about the health care reform law head on. And though he started with a bit of humor -- "Now, I have heard rumors that a few of you still have concerns about our new health care law" -- he quickly made one thing quite clear to anyone who might think he's taking the matter lightly:

"What I'm not willing to do," said Obama, "what I'm not willing to do is go back to the days when insurance companies could deny someone coverage because of a pre-existing condition."

However, Obama did agree that the health insurance reform law, which will extend coverage to 32 million uninsured Americans and "finally prevents the health insurance industry from exploiting patients," can be improved. He added that he's "eager" to work on any ideas brought forward to do that. But he emphasized his determination not to scrap the law: "So I say to this chamber tonight, instead of re-fighting the battles of the last two years, let's fix what needs fixing and let's move forward."

GOP Stands Firm on Repeal

Of course, the Republican reply to the State of the Union had a different take on what needed to be fixed. "The president mentioned the need for regulatory reform to ease the burden on American businesses," said House Budget Committee Chairman Paul Ryan (R-WI) in the GOP's official response address. "We agree -- and we think his health care law would be a great place to start."

"Health care spending is driving the explosive growth of our debt. And the president's law is accelerating our country toward bankruptcy," he said. Republicans "we will work to replace [the bill] with fiscally responsible, patient-centered reforms that actually reduce costs and expand coverage."

The Affordable Care Act came under renewed legislative attack from Republicans almost as soon as the new Congress was seated, and the House of Representatives voted to repeal it -- a symbolic gesture, given that the repeal measure won't be taken up in the Senate, and would never be signed by Obama.

It's unclear how well either party's plans for health care will sit with the public. Half of Americans now say they oppose the health care law, according to a recent Kaiser/Harvard poll. But the same poll showed a majority of Americans, including many Republicans, also disapprove of de-funding or otherwise slowing down implementation of parts of the bill. They, too, appear to prefer to move forward.

Looking for Savings in Social Security, Medicare, Medicaid

When it comes to the budget deficit and spending cuts, Obama's speech was light on details. He proposed a five-year freeze in annual domestic spending, outside of national security, Medicare, Medicaid and Social Security. But he also mentioned he will fund biomedical research, information technology and clean energy. Confusing?

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Further, Obama acknowledged the freeze alone would not be enough, and suggested that the nation would need to cut defense and health care spending, too, and reduce tax breaks and loopholes. "This means further reducing health care costs, including programs like Medicare and Medicaid, which are the single biggest contributor to our long-term deficit," Obama said. As for Social Security, the President is looking for "a bipartisan solution to strengthen Social Security for future generations."

While Ryan also offered few details about his fiscal proposals, his Republican Roadmap for America's Future calls for large cut in Social Security, Medicare and Medicaid. But the Kaiser/Harvard poll makes it clear that this is one thing the American public agrees on: They oppose large spending cuts to exactly these three programs.

With the Congressional Budget Office projecting a federal budget deficit of close to $1.5 trillion, or 9.8% of GDP in 2011, political leaders will have to tackle this problem head on. If they are to succeed, Democrats and Republicans will have to present a common front -- if one can be found -- before they demand large concessions from the American public.