What Has Health Care Reform Changed?

On its second anniversary, an Obama official shares the law's achievements, setbacks and evolution.

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TR: In the event that the mandate is stripped out, what is the administration's plan?

CM: We're not thinking about or planning for a moment when those provisions are not in the law. We really are quite confident that the Supreme Court is going to uphold it. So we're full speed ahead implementing the law and making sure that we can finish this job.

TR: A recent Washington Post-ABC poll found that a majority of Americans want the Supreme Court to strike down at least some of the law. Why do you think so many people have doubts about this legislation, and does that doubt concern the administration?

CM: This is certainly true in the congressional debate, and it continues to be true otherwise. There are a lot of misconceptions about the law, and a lot of exaggerated and overheated rhetoric that people use. But when you talk about its specific provisions -- like the protections against discrimination for people with pre-existing conditions, like the notion that insurance companies have to spend 80 cents of every dollar that they get in premiums on actual health care, as opposed to profits or bonuses -- by and large the public supports those things.

When you talk about the actual pieces of the law, you do a lot better than if you talk about the law as a whole, because that's when you get into the land of these misperceptions and exaggerated rhetoric that have really dominated this debate.

TR: Why has it been so difficult to get Americans to connect with the law as a whole?

CM: First of all, they're getting shouted at a lot. So part of the challenge is breaking through the shouting to make sure people have accurate information to help understand the law. But look, this is a major, major reform with a lot of moving parts and complexity. Those different pieces are not the subject of the yelling matches that you see on TV, but they are having a real impact in communities.

We're trying to talk about individual pieces of the law in ways that are more effective. For example, we're making investments under this law that are reducing the health care workforce shortage for the African-American community. We've invested in a National Health Service Corps program and have nearly three times the number of clinicians working in underserved communities across America, compared to three years ago.

TR: Over the past two years, the Obama administration itself has made changes to the law -- dropping the CLASS program for long-term care because it would be too hard to implement and, after backlash, compromising on contraception for religious-affiliated institutions. As you work on implementing the law, are you constantly learning things along the way that require adjustments?

CM: The CLASS Act is something that [Health and Human Services] Secretary [Kathleen] Sebelius felt, just in terms of cost, was unsustainable. So that's a change that she had the authority to make, and she made it.