Clarence Fanto: Health care law overhaul concerns are plentiful


LENOX -- It may be that Capitol Hill Republicans will continue to block the three major goals of President Obama's second term -- common sense gun laws, immigration reform and the ever-elusive "grand bargain" to reduce the nation's $16 trillion national debt while preserving safety-net social programs.

His frustration was evident at a White House news conference this past week, especially when Jonathan Karl of ABC News asked whether he still had the "juice" to persuade Congress to support the administration's agenda.

"Well, if you put it that way, Jonathan, maybe I should just pack up and go home," Obama responded with understandable annoyance at the suggestion that he's becoming a lame duck in year one of his second term. Citing Mark Twain, he added: "Rumors of my demise may be a little exaggerated at this point."

Some high-profile stars of the punditocracy are blaming him for failing to arm-twist Republicans to see things his way. That's more than a little unfair, since Congress has ignored the will of the people; polls show overwhelming support for modest gun-safety laws such as universal background checks and a reasonable path toward citizenship for 11 million undocumented immigrants.

But Obama's remark that the historic achievement of his first term -- the health care reform law -- "is working fine" is a stretch. Many people beg to differ.

The Affordable Care Act requiring all Americans to carry health insurance as of next Jan. 1 is the most sweeping new safety-net innovation since the advent of Social Security and Medicare. Those programs had rocky launches, as would be expected given their complexity and all-encompassing impact.

Concerns about the impact of the new law are many. How many employers are cutting their full-time staffs below 50, the threshold that requires businesses to offer coverage? Will premiums soar for people already insured? Will citizens now uncovered be able to navigate the application process?

One positive development: the application form for people seeking coverage has been simplified to three pages for individuals and seven pages for families, down from the previous, unwieldy 21-page draft.

Obama has pointed out that only 10 to 15 percent of Americans, about 30 million people, will be directly affected by the new law -- those who are uncovered or who have been buying their own insurance and paying exorbitant premiums.

"We're setting up a pool so that they can all pool together and get a better deal from insurance companies. And those who can't afford it, we're going to provide them with some subsidies," he explained. "That's it. I mean, that's what's left to implement, because the other stuff's been implemented, and it's working fine."

But many people remain confused by the new law. Sen. Max Baucus, the Montana Democrat who chairs the Senate Finance Committee, has said: "I just see a huge train wreck coming down."

Responding at his news conference, the president said that "despite all the hue and cry and the ‘sky is falling' predictions about this stuff -- if you've already got health insurance, then that part of Obamacare that affects you, it's pretty much already in place. And that's about 85 percent of the country."

Nevertheless, there's disquieting evidence from a recent Kaiser Family Foundation poll showing that 19 percent of Americans believe the health care law has been repealed by Congress or knocked down by the Supreme Court, while another 23 percent don't know if the law remains in place.

Among those with enough information to form an opinion, more people have a negative view than a positive one, although there's strong support for specific benefits of the program such as subsidies for low- and moderate-income Americans to help pay for coverage.

It's troubling that more than half of the states are resisting the expansion of Medicaid programs and the creation of online marketplaces so people seeking coverage can compare prices.

Will younger, healthy adults resist buying coverage and pay next year's $95 tax penalty instead? Will insurance companies boost their rates by double-digit percentages?

Here in Massachusetts, we're fortunate that our landmark health-reform law will become even more effective as additional middle-income families now uncovered by employers become eligible for subsidized insurance under Commonwealth Care.

But for the rest of the nation, and for Obama's legacy, there's nothing more important over the next few months than a successful rollout of the health care law. Bumps in the road are to be expected. But the president needs to focus on making sure the Affordable Care Act doesn't end up in a ditch.

Clarence Fanto is an Eagle
contributor. To reach him, email


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