WASHINGTON -- President Barack Obama chided Republicans during his State of the Union address Tuesday night for their repeated efforts to repeal the Affordable Care Act (ACA), and he challenged them to come up with a health reform plan of their own.
"If you have specific plans to cut costs, cover more people, and increase choice, tell America what you'd do differently," Obama said. "Let's see if the numbers add up, but let's not have another 40-something votes to repeal a law that's already helping millions of Americans."
The president was referring to the more than 40 House votes to repeal part or all of the law or change or block different aspects of it. The votes passed the House but none of the legislation was taken up by the Senate.
The line drew a long standing ovation from his Democratic lawmakers, but didn't draw a smile from House Speaker John Boehner (R-Ohio), who was seated behind the president.
Senate Republicans this week introduced their bill to replace the ACA, a bill that largely relies on tax credits to help cover the uninsured. The bill was co-sponsored by Sens. Richard Burr (R-N.C.), Tom Coburn, MD (R-Okla.), and Orrin Hatch (R-Utah).
Last fall, House Republicans introduced another ACA-replacement bill, a product of the Republican Study Committee and Health Care Working Group Chairman Phil Roe, MD (R-Tenn.).
But now that Americans are gaining coverage under the ACA, Republicans bear a greater burden, since Democrats only need to argue they know the ACA has problems that can be addressed, Bob Laszewski, president of Health Policy and Strategy Associates in Alexandria, Va., said.
"Republicans might have the bigger burden by arguing that we should go backward and repeal Obamacare, and then pass a detailed Republican plan that will have its own problems," Laszewski told MedPage Today. "I expect to see Democrats now on the health care offensive, arguing that they know how to fix Obamacare and the Republicans will just take us to more uncharted waters with a plan with its own issues."
In the Republican response to the State of the Union address, Rep. Cathy McMorris Rodgers (R-Wash.) mentioned a woman whose premiums were going up $700 per month under the ACA, and other people whose health insurance policies had been unexpectedly canceled or who could no longer see their current physicians.
"We shouldn't go back to the way things were, but this law is not working," she said. "Republicans believe healthcare choices should be yours, not the government's."
Obama said he was in the process of fixing a broken healthcare system. He delivered familiar talking points on what the ACA has accomplished, such as banning limits on pre-existing conditions and allowing dependents through age 26 to stay on their parent's health plans.
"Because of this law, no American can ever again -- none, zero -- be dropped or denied coverage for a preexisting condition like asthma, back pain, or cancer," Obama said. "No woman can ever be charged more just because she's a woman. And we did all this while adding years to Medicare's finances, keeping Medicare premiums flat, and lowering prescription costs for millions of seniors."
Although the president mentioned 9 million people have signed up for coverage under the ACA either through Medicaid or private coverage, he didn't mention the improvements Healthcare.gov has made since its rocky launch in October.
Obama encouraged those who know someone without health coverage to sign up for coverage by March 31 when the ACA's open enrollment ends.
"Moms, get on your kids to sign up," he said. "Kids, call your mom and walk her through the application."
The president promised to meet the needs of returning veterans, especially their need for healthcare and mental healthcare.
Obama also gave a nod to the work of the first lady and her "Let's Move" campaign, which seeks to encourage kids to eat healthier and exercise more.
"Michelle's 'Let's Move' partnership with schools, businesses, and local leaders has helped bring down childhood obesity rates for the first time in 30 years, and that's an achievement that will improve lives and reduce health care costs for decades to come," the president said.
Obama did not mention policy changes to Medicare as he did last year, when he suggested doing away with a fee-for-service payment system and paying drug companies Medicaid rates for patients dually eligible for Medicare and Medicaid.