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Did Health Care Speech Accomplish Obama's Goals?

STEVE INSKEEP, host:

Now let's take a closer look at what the president proposed.

NPR's Julie Rovner has been covering the story for years and was listening last night. She has been helping us all this year - keep our fact straight. Good morning, Julie.

JULIE ROVNER: Good morning, Steve.

INSKEEP: What changed last night, if anything?

ROVNER: Well, you know, until now, we've been talking about the president's planned this - the president's planned that. But, there really wasn't a president's plan. There were all of these plans floating around on Capitol Hill. There rather purposely wasn't a president's plan. President Obama had left all the details to Congress. He had given them sort of a page of guidelines. And this, I think, was an effort for there to become a president's plan. Now, what he laid out was similar to what a lot of the Democrats in Congress have been doing, but not identical. I think there was also a big shift in emphasis. Until now, there had been a lot of talk about really how to help people who didn't have insurance and not too much on really looking at those people - the 160 - 180 million people who have insurance - really what's in it for me? So, let's listen.

(Soundbite of applause)

President BARACK OBAMA: They'll no longer be able to play some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime.

(Soundbite of applause)

Pres. OBAMA: We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America no one should go broke because they get sick.

(Soundbite of applause)

ROVNER: So, changes in the rules for insurance. That what's on offer for those with insurance - what about those without insurance?

ROVNER: Well, very much like most of the plans that are floating around in Congress, the president is promoting something called health insurance exchanges. These are marketplaces where individuals and small businesses could go to buy insurance. Here's how the president explained it last night.

Pres. OBAMA: If you lose your job or you change your job, you'll be able to get coverage. If you strike out on your own and start a small business, you'll be able to get coverage. We'll do this by creating a new insurance exchange, a marketplace where individuals and small businesses will be able to shop for health insurance at competitive price.

ROVNER: And for individuals and small businesses who can't afford the cost, there will subsidies and tax credits. And that's, of course, what accounts for most of this bill's big price tag.

INSKEEP: Hundreds of billions of dollars over a decade.

ROVNER: Indeed.

INSKEEP: And we should note that under the president's plan, as laid out last night, if you don't have insurance right now, you're going to be required to get it.

ROVNER: Yes. In most cases, there are some hardship exemptions. That's a flip-flop from his primary campaign. He was actually the only Democrat who did not endorse that. But that's what they do in Massachusetts, so that's a big piece of this.

INSKEEP: Massachusetts, one of the states that's got something like universal health coverage or something close to that. Why would the president change on that?

ROVNER: Well, in fact, it was made finally clear to him that the system really doesn't work unless everyone is in it. It's really the only way to cover everyone, is if everybody has insurance. It's what they called shared responsibility.

INSKEEP: Julie Rovner, the president said he was embracing some Republican ideas; try to take this very partisan issue right now and try to position himself as being bipartisan. Is he embracing Republican ideas?

ROVNER: A few. He did make sort of a nod in the direction of doing something about medical malpractice lawsuits and defensive(ph) medicine, endorsing some demonstration projects. There were a couple of Republicans that said that's a nice thing.

He didn't go very far in that direction. He talked about Senator John McCain's idea to have high-risk pools for people who couldn't get insurance, that that might be an interim step while they're waiting for these preexisting condition exclusions to come into effect four years from now if this were to become law.

INSKEEP: So, a little bit there; not too much. The president actually got booed at one point, by Republicans, when he said that illegal immigrants would not be covered under his plan. Let's listen:

Pres. OBAMA: There are also those who claim that our reform efforts would insure illegal immigrants. This too is false.

(Soundbite of booing)

Pres. OBAMA: The reforms I'm proposing would not apply to those who are here illegally.

Representative JOE WILSON (Republican, South Carolina): You lie.

(Soundbite of booing)

INSKEEP: Now, in the middle of that booing, you can hear Representative Joe Wilson of South Carolina shout out, you lie. There's been a lot of the coverage of the etiquette of this. Wilson has apologized, but let's ask about the substance. Was the president truthful in saying that his plan is not going to cover illegal immigrants?

ROVNER: Yes. The president was truthful in saying the plan does not give benefits to illegal immigrants. The Republicans are complaining that there are loopholes in the plan that would let illegal immigrants get benefits anyway. This is because the Democrats have rescinded some rules that were so onerous that it was preventing citizens from actually getting benefits.

INSKEEP: And just very briefly, in a few seconds, is it clear now, that the president is going to be able to extend coverage to millions of people - which costs a lot of money - and still save money on a health care system that he says is spending too much money?

ROVNER: That's the hard part. Congress is still working on it. It's going to take several more months to see if that could be figured out.

INSKEEP: Julie, thanks very much.

ROVNER: You're very welcome.

INSKEEP: NPR's Julie Rovner in our studios in our morning.

(Soundbite of music)

INSKEEP: It's MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Steve Inskeep is a host of NPR's Morning Edition, as well as NPR's morning news podcast Up First.