(Bloomberg) — The Affordable Care Act is the best chance for the U.S. to achieve near universal medical coverage and curb health care costs that hurt the nation’s global competitiveness, former President Bill Clinton said.

Clinton, who left office in 2001, said the law addresses many of the U.S. system’s biggest deficiencies. At the same time, he outlined changes he says need to be made going forward in the law and urged foes to work with proponents to strengthen it piece-by-piece, rather than seeking to repeal it.

Clinton’s speech, from Little Rock, Arkansas, comes just weeks before the exchanges are set to begin selling coverage to uninsured Americans under the health care overhaul. That task has been complicated by public confusion about its status and attacks by opponents, spurring the Obama administration to turn to Clinton to help clarify it.

“I agreed to give this talk today because I’m still amazed at how much misunderstanding there is about the current system of health care, how it works compared to what other people in other countries pay for health care and what kind of results they get, and what kind of changes are occurring now and are going to occur in the future,” Clinton said.

The ACA aims to reduce medical costs and extend insurance coverage to at least half of the nation’s 50 million uninsured.

Starting Oct. 1, people with low incomes can sign up for either private plans with premiums subsidized by taxpayers or Medicaid, the health program for the poor that will be expanded in about half the states.

Unhealthy system

“It’s better than the current system, which is unaffordable and downright unhealthy for millions of Americans,” Clinton said in the speech, which leaned heavily on statistics to make his point.

The law can work, Clinton said, but only if Congressional Republicans work with Democrats to “identify the problems and fix them, instead of replaying the same old battles.”


A group of Republicans led by Senators Mike Lee of Utah and Ted Cruz of Texas are pressuring their colleagues to refuse to agree to a fiscal 2014 spending bill for the federal government that includes any funding for the health care law. Congressional Republican leaders have so far demurred from a budget standoff with Obama over the issue.

Three issues

During his speech, Clinton outlined three issues with the law that he said Congress and state leaders in both parties should work together to fix:

  • Subsidies aren’t available to families of workers whose employers have given them individual insurance plans that fail to cover their dependents. Clinton said this was an “unintended consequence” that “has got to be fixed.”
  • A tax credit given to small businesses who buy coverage for their workers in the exchanges “doesn’t work very well,” he said. It needs to be improved and made available to more firms, according to Clinton.
  • States that have refused to expand Medicaid have created a dangerous gap in coverage, he said. People earning wages less than the poverty level “are eligible for nothing” and won’t get subsidies to buy insurance on exchanges, according to Clinton. He called the problem “a whopper.”

Critic warnings

At the same time, issues that critics have been warning about haven’t materialized, he said. Computer systems built to manage the overhaul appear to be working well so far, he said, calling the effort by state and federal officials to get the systems up and running “remarkable.”

“There may be glitches,” he said. “But so far there’s no evidence to suggest they won’t be able to be fixed quickly.”

Additionally, he said there was little evidence employers were shifting large numbers of workers to part-time schedules or dropping their health plans to avoid the law’s requirement that they provide insurance.

“So far, the direst predictions of adverse consequences haven’t materialized, and I don’t believe they will,” he said.

Clinton’s own attempt to overhaul the U.S. health care system in 1993 failed when Congress didn’t pass legislation and his party lost control of the House of Representatives in the 1994 elections. Democrats avoided the issue for more than a decade thereafter.

Obama has called on Clinton’s prestige before, including during his 2012 re-election campaign. Clinton appeared at fundraising events and in campaign ads that culminated in a rousing speech to the Democratic National Convention in support of Obama’s economic policy and first-term achievements.

A White House aide, Dan Pfeiffer, jokingly called the former president the “Secretary of Explaining Stuff” when Clinton’s plans to give the speech were announced last month.

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