Understand how we got here — and how to move forward.

Blog Post

What to expect in tonight's State of the Union

January 28, 2014

    Dan Diamond, Managing Editor

    The state of is…strong?

    We may find out tonight, as President Obama delivers his sixth State of the Union address—a speech that the White House says will be focused on "opportunity, optimism, and action."

    Based on the Obama administration's own rhetoric, nothing better encapsulates those qualities than health reform, and it's a cinch that the president will use Tuesday's speech to tout his law. Still, health care hasn't been a major focus in the president's recent State of the Union addresses; Obama spoke the most about health care when he was exhorting Congress to pass the bills that would become the Affordable Care Act. He retreated from discussing the actual law during the 2012 election year, when the ACA was a political hot potato.

    And while health care played a larger role in last year's address, Obama concentrated more on potential Medicare reforms than his signature reform.

    This year, the playing field is a little different. The ACA's gaining in the polls—or at least, losing negatives—and the president can point to actual success stories.

    What tonight's speech is, and isn't

    Political analysts have come around to a new way of thinking about the State of the Union address: It's more of a pageant than a bully pulpit.

    The address doesn't do much for the president's approval rating. It doesn't really change the "national conversation."

    What it does do is signal the White House's policy goals for the coming year. And on the health care front, it's an opportunity for the president to enjoy a victory lap with his supporters while trying to give the "big sell" to ACA holdouts, Piper Su told me. (Su is the Advisory Board's vice president of health policy.)

    He may "acknowledge the bumpy start" to the law's insurance exchanges, Su added, "but the story is going to be that all is right with the world—whether it is or not."

    That's just one of the things that health wonks will be watching for in tonight's address. Here are five others:

    Touting the latest enrollment numbers: Tonight's speech "will be Obama’s most high-profile address since the clunky [exchange] rollout began," David Nather notes at Politico. And despite rough beginnings, the latest statistics suggest that more than 3 million Americans have used the ACA's new health insurance exchanges to get private coverage.

    Millions more—the White House says at least 3.9 million, but that may be an inflated total—have been found eligible for Medicaid and other public health programs, too.

    Touting early success stories from the ACA: The president will likely try to put a human face on those numbers. "Keep an eye out for a few heartwarming stories tonight," Su notes.

    Obama may also try to recognize leaders and supporters who have helped lead ACA implementation. Kentucky Gov. Steve Beshear will be a guest of the first lady, and his state has received acclaim—including high praise from the president—for "setting the pace" on coverage expansion.

    What's the state of ACA implementation? Join us for a conversation on March 19 as our experts perform a pulse check on Obamacare.

    Pressuring lagging states to expand Medicaid: On the flip side, states like Florida and Texas continue to hold out on accepting the ACA's Medicaid expansion. But they're increasingly in the minority, now that most states—thanks to Utah's announcement last week—have committed to some form of coverage expansion under the law.

    And others may follow suit. While GOP governors treated the Medicaid expansion as a political non-starter for several years, there are increasing signs that Republican leaders are amenable to accepting federal dollars that the law would bring.

    Offering potential entitlement cuts: Deficit negotiations remain a key political issue, and the president may raise Medicare reforms as a negotiating point with Republicans. There's also a strong chance he'll point to the slowing rate of Medicare spending, too, suggesting that the ACA has played a major role in bending the curve.

    Calling out the nation's health innovations: This is a politically neutral topic for the president—and a familiar one. In two previous SOTU addresses, Obama touted how the nation is developing "treatment that kills cancer cells but leaves healthy ones untouched."

    Update, January 29: President Obama ended up focusing quite a bit on the Affordable Care Act on Tuesday night, giving health care its most airtime in a State of the Union address since 2010. Today's Daily Briefing offers a quick summary of the president's remarks, and you can see how the word count shakes out via the chart below.

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.