After surviving Supreme Court challenge, what’s next for Obamacare coverage and cost?

Since the Supreme Court upheld the Affordable Care Act, what’s next for ensuring the health of the health reform law? Judy Woodruff speaks to Secretary of Health and Human Services Sylvia Burwell about its successes and what can be improved.

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    In the wake of the Supreme Court's decision to uphold the health care law, the president headed to Nashville today to make the case that more states should participate. More than 20 states, mostly led by Republicans, have rejected an expansion of Medicaid, including in Tennessee.


    And the federal government is there to help and to work with those states that are ready to get going.

    I will tell you, the states that have taken full advantage of all the federal options available, they have an even lower uninsured rate and a healthier population, and more people signing up for the options that are available than those state how have not taken full advantage of those options. And that's just a fact.


    We pick up on what happens now to the health care law and the issues surrounding coverage and costs.

    Department of Health and Human Services Secretary Sylvia Burwell is the point person for the administration.

    Sylvia Burwell, welcome.

    SYLVIA MATHEWS BURWELL, Secretary of Health and Human Services: Thank you so much for having me.


    So the administration just won this big victory in the Supreme Court just last week, the president already out on the road saying it needs to be improved, the health care law.

    How do you know this is a wise approach when, I guess, half the American people say they're still not sure they like the law?


    Well, I think what we want to do is use this as an opportunity to build on the progress that's been made.

    And whether that's the progress that's been made for those that are in the employer-based market, those that no longer can be kept out of insurance because of preexisting conditions or can keep their child on until 26, or those that are newly insured, we have made a lot of progress.

    And what we want to do is turn now and build on that progress and use this moment as an opportunity to move forward.


    I'm sure you know very well Republican members of Congress, Republicans running for president are saying they want to either completely repeal the law or undo big chunks of it.

    How worried are you that they may do that either in the next year-and-a-half or when there is a new president?


    Well, you know, I think the president's been clear about the issue of repeal.

    And what we're hoping is that the conversation can turn to the substance, and I think that's what the president was reflecting today, in terms of most Americans want to make sure — they don't want to go back to a time where you can't get insurance if you have preexisting conditions or your children up to 26, or in terms of the consumer protections that are in place, and whether that's lifetime limits no longer exist or annual limits no longer exist.

    And I don't think folks want to go back to that. And so I think what we want to do is focus on there has been a lot of progress made in terms of quality, affordability and access, but we believe that there is more that can be made, and we would like to work together to do that.


    Well, let's talk about some of the modifications that have been discussed. Even people who support the plan are saying there are parts of it that need changing, the so-called Cadillac tax on the more generous plans.

    The thinking is that this could cause employers to cut back on benefits, to pass along the cost. Is that something that the administration is willing to take a look at and maybe get rid of?


    So, with regard to what we said about the things we want to look at, and how we're going to think about each of those things is in terms of, how does it impact access, affordability and quality, and what does it do in terms of the deficit and the health of the economy.

    These are the things that, for all the issues, we're ready to have the conversation in terms of — in our budget even, we actually have proposed extending some of the tax credits to a larger group of small businesses. In our budget, we have also proposed things that we think will help with increasing costs in the pharmaceutical space as well.

    And that's about making sure we have the ability to negotiate with pharmaceuticals about price for Part D and Medicare.


    And what about the Cadillac tax?


    As I said, in terms of that one, there is the issue of what it means in terms of the deficit. That is a very expensive thing. And so, as we think about that, that's one of the things that we think is problematic in that space.


    As you know, also, one of the persistent criticisms of the law and health care in general is that the costs is so high, that premium costs are high.

    We looked at some numbers today. In many places, people are paying 10 percent, 20 percent, even 30 percent of their gross income for these premiums. How do you reverse this trend, which seems to be happening in places all over the country?


    So, first, I think it's important to recognize that in terms of premium growth, that we have seen some of the lowest premium growth in the employer-based market that we have seen in many, many years in terms of a decade.

    We have also seen that price increases in the health system are at some of the lowest in decades. With regard to what we're seeing now in terms of some of the premiums that have been posted and are being talked about, those are the proposed premiums.

    And part of the Affordable Care Act created a process of transparency and review. So when insurers are going to charge more than a 10 percent increase, that needs to be reviewed and there needs to be justification. The Affordable Care Act actually has put in place things that we believe both increase transparency and increase downward pressure on the premiums, but I think everyone knows, before the Affordable Care Act, we saw these premium increases that existed as well.


    Let me ask you about the difficulty in getting people to sign up. This is something I know the administration's worked very hard on.

    But even today, we're told something like 18 million Americans who are eligible who are uninsured still have not signed up, decided to buy insurance. Many of these are Hispanic, young people, young men. How do you reach out to these individuals? How do you persuade them to sign up when they haven't been willing before now?


    So, we know a couple of things.

    First, 16.4 million fewer Americans are uninsured now. And that is progress and progress we want to build. We want to do this year as part of our open enrollment and focus, as we did last year, on meeting the consumer where they are, making sure that we understand what these consumers are making their choices on and that they have the information they need to make good decisions and know that they can find affordable, quality care.

    We know that many people don't realize that there are tax credits that can help make it affordable. We also know that many people, differing groups need to be — have individual contact. And that's why we use navigators and assisters, so that people can ask the questions of an individual and have a conversation about what is a very important and personal matter.


    And, of course, another important part of this is coverage for low-income individuals, for the poor, Medicaid. A number of governors, a number of states have said they are not going to go along with expanded Medicaid coverage.

    There is difficulty. We know the administration is going to be reducing, I guess, from 100 percent down to 90 percent of the portion it covers. You still see state leaders saying this is something they can't afford to do. How do you persuade them otherwise?


    Well, first, I think it's important that the 100 percent goes through 2016.

    So, for many governors, it's important to go ahead and fully get that 100 percent payment that the federal government is willing to make in terms of expanding and providing coverage for many working people in their state who can't afford that coverage right now.

    And we believe that, in terms of the expansion, it's important for two fundamental reasons. One is for the individuals. And those individuals, as I said, many are working, are people who can get health security and financial security by the expansion.

    I think the other thing that's important is what this does mean in terms of jobs and the economy. And in Kentucky, where they did expand, they have done studies so that they make sure they track what's happening. And a study done by Deloitte, as well as the University of Louisville, showed that, in the state of Kentucky, by the year 2021, they expect 40,000 new jobs to be created because of the expansion and $30 billion to flow into the budgets of the state of Kentucky.


    So that's something you will think is going to happen elsewhere?


    We think it is. And we think that it's because of the substance in terms of what it means in the states, both for individuals, as well as for the states' economies and providers in those states.


    Sylvia Burwell, secretary of the Department of Health and Human Services, thank you.


    Judy, thanks for having me.

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