Looking back on 2014: Fact checking the president on health care
The president never specifically mentioned the Affordable Care Act (ACA) in his address, and although he name-checked Medicare and Medicaid—which together account for more than one-fifth of all federal spending—the two programs got just one brief mention in the speech. That's in stark contrast to previous years, when such issues were prominent components of the president's agenda.
Nonetheless, Obama made several assertions about the state of health care in America:
- On insurance coverage: Obama last night said "more of our people are insured than ever before." The latest polling information from Gallup suggests this is probably true, with the uninsured rate dropping to 12.9% in the last quarter of last year. Obama also said, "in the past year alone, about ten million uninsured Americans finally gained the security of health coverage." He was probably referencing a number taken from this 2014 study in NEJM, which found that an estimated 10.3 million Americans gained coverage since the beginning of the ACA's first open enrollment period. Here's how that change has played out in each state:
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- On health care spending: The slowdown in the growth of health care spending got a nod. "Health care inflation at its lowest rate in fifty years," Obama said. The latest data released by the administration suggests this is true: According to a report published in Health Affairs, health care spending in 2013 grew by 3.6%, the slowest rate since 1960. It's important to note, however, that the slowdown in health care spending began before Obama took office.
- On veterans' health care: The president alluded to claims disability backlogs at the Department of Veterans Affairs and a major wait-time scandal that rocked the VA and led to the resignation of a member of Obama's Cabinet. He claimed, "Already, we've made strides towards ensuring that every veteran has access to the highest quality care. We're slashing the backlog that had too many veterans waiting years to get the benefits they need." Data from the VA suggests that these are still major problems, but the backlog has decreased from about 600,000 claims in March 2013 to fewer than 250,000 claims. And in November, VA Secretary Robert McDonald said that wait times within the VA health system had decreased by 18% since May.
- On jobs: Obama did not specifically mention health care when he explained how, "[s]ince 2010, America has put more people back to work than Europe, Japan, and all advanced economies combined." But health care has been a key driver of that growth—especially in 2014.
- On Ebola: Obama honored the people on the ground working to contain the deadliest outbreak of Ebola in history. "In West Africa, our troops, our scientists, our doctors, our nurses, and health care workers are rolling back Ebola—saving countless lives and stopping the spread of disease," the president said. However, he added that "the job is not yet done—and the world needs to use this lesson to build a more effective global effort to prevent the spread of future pandemics, invest in smart development, and eradicate extreme poverty." Even though the panic that gripped the United States in the fall has faded, the president is right here. By the latest count from the World Health Organization, there have been more than 21,000 confirmed cases and 8,400 deaths in the current outbreak—and it's far from over.
- On abortion access and teen pregnancies: The president included a brief mention about the progress on these issues. "We still may not agree on a woman's right to choose, but surely we can agree it's a good thing that teen pregnancies and abortions are nearing all-time lows." According to federal data, U.S. abortion rates hit a historic low in 2011, and the teen birth rate dropped from 61.8 births for every 1,000 adolescent females in 1991 to 26.6 births per 1,000 in 2013. (However, it's worth noting that the teen birth rate in the United States remains high compared with other developed nations.)
In addition to these health care mentions, Obama reminded the newly Republican Congress before him that efforts to repeal the ACA would be met with a red pen. He said, "We can't put the security of families at risk by taking away their health insurance… And if a bill comes to my desk that tries to do any of these things, it will earn my veto."
On the agenda for 2015: How Obama's proposals could affect health care
Obama' sixth State of the Union included only one health care-specific proposal: A deeper commitment to the development of personalized medicine.
He said, "21st century businesses will rely on American science, technology, research and development. I want the country that eliminated polio and mapped the human genome to lead a new era of medicine—one that delivers the right treatment at the right time." This statement is especially poignant in light of a report released this month that suggested the United Sates is falling behind in its commitment to medical research funding.
"Tonight, I'm launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes—and to give all of us access to the personalized information we need to keep ourselves and our families healthier," Obama said. We expect more details on this initiative in the coming days.
Obama also outlined several proposals that could have an important impact on the health care sector. Here's a brief overview:
- Community college: The president discussed his plan to eliminate tuition for community college, provided students meet certain requirements. "I am sending this Congress a bold new plan to lower the cost of community college—to zero," he said. The Daily Briefing last week reviewed how Obama's proposal to make community college free could mean more qualified workers for health care at an important moment for the industry. Analysts have noted that the plan could cost $60 billion over 10 years, and that students' completion rates for community college have been consistently low.
- Paid sick leave: "Today, we're the only advanced country on Earth that doesn't guarantee paid sick leave or paid maternity leave to our workers," Obama said, adding, "So I'll be taking new action to help states adopt paid leave laws of their own." He also urged Congress to "[s]end me a bill that gives every worker in America the opportunity to earn seven days of paid sick leave." We have a deeper look at his proposal here.
- Cybersecurity: "I urge this Congress to finally pass the legislation we need to better meet the evolving threat of cyber-attacks, combat identity theft, and protect our children's information," Obama said. A report from the Ponemon Institute last year found that about 90% of health care organizations exposed their patients' data or were the victim of a data breach in 2012 and 2013—more than organizations in any other industry.
- Cuba: "In Cuba, we are ending a policy that was long past its expiration date," Obama said. You might not expect it, but Obama's plan to normalize relations with Cuba after decades of isolation has important implications for both countries' health care system. For instance, it could increase Cuban doctors' access to U.S.-produced medical devices and drugs, while opening the door to bringing promising Cuban drugs to America.
- Internet access: Obama said, "I intend to protect a free and open internet, extend its reach to every classroom, and every community, and help folks build the fastest networks, so that the next generation of digital innovators and entrepreneurs have the platform to keep reshaping our world." Broader access to high-speed Internet can be important for data sharing in health care and for patient access to health information.
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The takeaway: President Obama's sixth State of the Union may have been light on specific mentions of health care—but the agenda that it outlined could have major implications for the sector.