What Obama didn't say in his State of the Union address


As I watched President Barack Obama deliver his State of the Union speech earlier this week, I couldn't help but wonder whether he could have done more to address healthcare reform.

Although he urged people to enroll in health insurance exchanges, calling out moms and kids to help each other, I don't think he  went as far as he could have.

Sure, he highlighted several reform successes, which also happen to be some of the most popular aspects of the law, by reminding everyone that they can't be denied insurance coverage because of pre-existing conditions, for example.

And yes, he emphasized that more than 9 million people have signed up for either private or Medicaid coverage since the reform law was passed.

Obama also admonished Republicans for their continual attempt to repeal and replace the Affordable Care Act while simultaneously challenging them to come up with something better.

"I know the American people are not interested in refighting old battles, so, again, if you have specific plans to cut costs, cover more people, increase choice, tell America what you'd do differently," he said. "Let's see if the numbers add up."

But here's what he didn't do: directly reach out to the critical young adult population. It seemed to me that Obama was only hinting that young adults would be better off insured than fearing that the worst might happen. "That's what health insurance reform is all about--the peace of mind that if misfortunate strikes, you don't have to lose everything," he said.

But I think you need more than a wink and a nod to effectively reach young adults.

Young adults are among the group of consumers least likely to sign up for a health plan, comprising just 24 percent of total exchange enrollees so far. Yet they're key to the success of the ACA and insurers as well. Why not call them out directly? Point out clear, evidence-based reasons why it would benefit them to buy coverage instead of paying a fine.

What's more, his healthcare-related comments lasted about five minutes in his hour-long address. Whether you like the reform law or not, it's one of Obama's biggest accomplishments of his presidency thus far. Now that the ACA is almost in full effect, I expected it to account for more than 7 percent of the president's national speech.

Obama's healthcare comments were so short that he didn't even mention an audience member who was invited by the White House to join Michelle Obama in the first lady's box, noted Politico. Adam Ripp was diagnosed with cancer and would have lost his health insurance if it wasn't for the aspect of the reform law that prevents insurers from dropping members with expensive conditions. Ripp could have served as a prime example of a person explicitly benefiting from the reform law.

And it would have been amazing if Obama could have declared the HealthCare.gov website fixed and glitch-free on national television. That statement alone, if only it were true, could have driven millions of consumers to enroll in the federal marketplace and increase insurers' membership. Of course, accomplishing that feat would have taken a herculean effort that our federal bureaucracy just isn't able to produce at this point.

But back to reality.

Just a few minutes into his message to the American public, Obama said "I believe this can be a breakthrough year for America." He added that he wants to make 2014 "a year of action."

Although he wasn't speaking specifically about healthcare, I do think Obama's words apply to the insurance industry. But it's up to health insurers to take care of themselves. As this State of the Union speech clearly shows, insurers can't rely on government efforts to bolster their post-reform market positions. They must do the work to recruit exchange enrollees before they can reap the rewards. I'd like to see insurers adopt Obama's goal, working to make 2014 a breakthrough year in the post-reform insurance industry. -Dina (@HealthPayer)