Six years ago, candidate Barack Obama stood before Iowa voters and unveiled a plan designed to extend health care to all Americans.
"We can do this," he said with confidence. "The time has come for universal, affordable health care in America."
Three years ago,
President Barack Obama signed into law a plan designed to extend coverage to more than 30 million uninsured people.
"This is what change looks like," he exulted.
Not so fast.
Obama's message now boils down to this: Be patient, not yet, adjust your expectations.
A look at how the scope of Obama's health-care plan has narrowed in recent years:
PUBLIC OPTION? Never mind.
Obama once trumpeted the idea of providing a public option in health care, in essence a government-run plan that would be one of many choices for people seeking affordable care. That idea, popular with liberals but opposed by conservatives and many moderates, never made it into the health-care law. In the quest for a workable compromise, Obama deemed it expendable.
LONG-TERM CARE INSURANCE? Buh-bye.
When the president signed his health-care plan into law, it included a proposal to provide basic long-term care insurance at an affordable cost. Before the program ever got off the ground, though, the administration ditched it last spring for fear it would turn into a financial drain. It could take be years before lawmakers to tackle the issue again.
COVERAGE FOR THE NEEDIEST? Not in every state.
The law envisioned millions of the neediest Americans gaining health insurance by enrolling in Medicaid, with coverage starting in January. But the Supreme Court threw a wrench in that plan last year when it gave states the right to opt out of the Medicaid expansion plan. Because of Republican opposition in many states, it looks like nearly 2 in 3 of those who would qualify for new Medicaid coverage may be out of luck because their state lawmakers have not agreed to expand the program.
WHAT ABOUT WORKERS? A longer wait.
The law requires companies with 50 or more workers to offer affordable coverage to full-time employees or risk a series of escalating tax penalties. Originally, that requirement was supposed to take effect on Jan. 1, 2014. But now the administration is pushing that requirement back a year, citing the complexity of the undertaking. Most medium and large business already offer health insurance. Those most likely to be affected by the delay: low-wage workers at hotels, restaurants and stores.
WHAT'S LEFT? Plenty.
Starting next year individuals will be required to carry health insurance or face fines. People who are uninsured will be able to shop for affordable coverage through online marketplaces. Middle-class people who don't have coverage through their jobs will use the marketplace to apply for tax credits to help pay their premiums. Low-income people will be steered to the Medicaid expansion — if their state participates. Insurance companies will be required to accept people regardless of their medical problems. A number of other changes already have taken effect, including a provision that allows young adults to stay on their parents' insurance until age 26 and a ban on lifetime limits on insurance coverage.
MORE...
Even though some firms won't have to offer insurance next year, workers can still get it.
The sudden delay of a major part of President Obama's historic health-care overhaul is raising questions about other potential problems lurking in the homestretch.
The requirement that many employers provide coverage is just one part of a complex law. But its one-year postponement has taken administration allies and adversaries alike by surprise.
White House officials said Wednesday that the delay was firm and would not be extended after a year - and that the overhaul will still be fully implemented by the time Obama leaves office. But the officials, who were not authorized to discuss internal deliberations on the record and spoke only on condition of anonymity, wouldn't rule out delays or tweaks to other provisions.
The White House action means that some companies that would have offered health insurance next year to avoid fines will not do so now. They're mainly firms with many low-wage workers, such as restaurants, hotels and temporary staffing companies.
The workers, however, will still be able to get coverage. Many may qualify for subsidized insurance through new marketplaces to debut Oct. 1, less than three months away.
The fact that new problems are popping up at this late stage could be a sign of additional troublesome issues ahead. It underscores a recent warning by the Government Accountability Office that the "timely and smooth" rollout of the new insurance markets can't be guaranteed, partly because much of the technology to run them hasn't been fully tested.
The timing of the announcement was also widely mentioned.
"It's understandable that when you announce a change in the law just before the Fourth of July holiday, it raises questions," said Drew Altman, president of the nonpartisan Kaiser Family Foundation. "Critics will jump on it and use it as more ammunition against the law."
The foundation is a research group that has closely followed the evolution of the health law since it was signed in 2010.
The development was seen as noteworthy by both critics and allies of the new law.
"We are concerned that the delay further erodes the coverage that was envisioned," said Rich Umbdenstock, president of the American Hospital Association, which has supported the Affordable Care Act.
Just over a week ago, Health and Human Services Secretary Kathleen Sebelius officially launched the 100-day countdown to the new insurance markets. Uninsured Americans in all 50 states and Washington, D.C., will be able to shop online for health plans, and most will get government subsidies to pay their premiums for coverage that takes effect Jan. 1.
White House senior adviser Valerie Jarrett wrote in her blog that the administration is "on target" to open the new health insurance markets and it's "full steam ahead."
