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Obama heads to high-stakes Texas to sell health care law

WASHINGTON, DC - NOVEMBER 04:  US President Barack Obama delivers remarks at an Organizing for Action \"Obamacare Summit\" at the St. Regis Hotel on Nov...
WASHINGTON, DC - NOVEMBER 04: US President Barack Obama delivers remarks at an Organizing for Action "Obamacare Summit" at the St. Regis Hotel on November 4, 2013 in Washington, D.C. Obama spoke on health care and rallied over 200 supporters to get uninsured consumers to purchase a plan through the Affordable Care Act. (Photo by Ron Sachs-Pool/Getty Images)Pool / Getty Images
WASHINGTON, DC - NOVEMBER 04: US President Barack Obama delivers remarks at an Organizing for Action
President Barack Obama will head to Texas Wednesday to persuade uninsured residents to sign up for the health care exchange.Pool / Getty Images

President Barack Obama is headed to Texas on Wednesday to encourage some of the 6.3 million people there without health insurance to sign up on the new online exchange — even as critics accuse the administration of completely botching the rollout and supporters worry that the controversy has scared people away.

His message: Health care is beyond politics, White House deputy senior adviser David Simas told reporters. Obama is headlining a White House effort to move the debate away from the troubled exchanges and complaints by people whose coverage has been canceled or whose premiums may rise under health reform.

More important, Obama will argue, are the benefits the law brings — ending health insurance policies that cut people off when they start costing too much to cover; policies that deny health insurance to people with pre-existing conditions; and making policies more affordable by offering tax credits.

He's picking Texas for a reason. The Lone Star state has more people without health insurance than any other state, about a quarter of its population. And it’s one of the states that has refused to expand Medicaid as called for under the 2010 Affordable Care Act, so millions will be left without coverage even if people do go to the exchanges to get federally subsidized health insurance.

Obama’s first stop will be Dallas, Simas says, where 670,000 people don’t have health insurance. “It’s a key place to reach young consumers,” Simas said on a conference call. Obama will meet volunteers trying to help people enroll.

Gov. Rick Perry and the state legislature are saying no to $76 billion that the federal government would pay to support the expansion of Medicaid over the next five years; a figure that climbs to $90 billion over 10 years.

“That money in the economy is unprecedented,” Garnet Coleman, a Democrat in the Texas state legislature who represents much of Houston’s poor downtown, told reporters on the call.

“The jobs in health care are good jobs. They are jobs that pay well. They come with health insurance and they come with the opportunity to move up.”

Right now, Texans are paying for people without insurance through higher property taxes that in turn support hospitals providing care to patients who show up in the emergency room for treatment, Coleman says.

People with health insurance, many experts argue, end up in the ER less often because they get routine preventive care. The 2010 Affordable Care Act requires health insurers to provide that care, such as cancer screenings, with no charge to the patient.

“If it makes sense anywhere in the United States to expand Medicaid, it makes sense in Texas,” said San Antonio Mayor Julian Castro, who joined Simas and Coleman on the conference call.

The 2010 Affordable Care Act was designed to transform health care in the United States, which most experts agree currently costs too much and leaves far too many people without health insurance. The exchanges are one part of this.

Earlier Tuesday, the nonpartisan Kaiser Family Foundation released a study showing that 17 million people who have no health insurance now or who buy insurance on their own will be eligible for government subsidies to help pay their premiums next year. “We also estimate that about 29 million people nationally could look to new marketplaces as a place to purchase coverage,” the report reads.

The ACA also meant to provide more care to people who can’t buy insurance by forcing states to expand Medicaid. The hope was to add about 16 million of the poorest people to the rolls — about half of those who need health insurance. But after a series of challenges to the law, the U.S. Supreme Court ruled in June that the Medicaid expansion requirement went too far and states could opt out.

Obama, who visited Massachusetts last week, will point to Republican-led states such as Ohio and Arizona that have chosen to expand Medicaid, Simas says.

While Obama was planning his trip to sell the exchanges as a way for people to get insurance, Republicans in Congress kept up their pressure on the administrators running them.

House Ways and Means Committee chairman Dave Camp, a Michigan Republican, said late Tuesday he had issued a subpoena to Center for Medicare and Medicaid Services administrator Marilyn Tavenner asking for the enrollment figures for

Tavenner said on Tuesday that CMS would have those numbers next week. Camp’s subpoena said Congress needs them sooner.

"Congress needs to know what you know so Congress, the American people's representatives, can also take corrective action," Camp wrote in a letter accompanying the subpoena.

"Both Republicans and Democrats need to understand the full extent of the crisis if we are going to find a fair and workable solution for the American people."

The committee also released pages of notes  from "war room" meetings showing detailed day-by-day discussions of the website's troubles.

Tavenner says the site is being fixed and says it can handle 17,000 people a day now. She also said the administration has been planning all along for people to wait until the last minute to sign up —one big batch in December, and another batch in February and March.

Camp says the system won’t be able to handle the numbers of people needed to enroll. “To meet its own projections, the administration would need to have a system in place capable of enrolling 100,000 people a day for the entire month of December. There is no evidence this system is capable of handling this type of volume, which threatens to leave Americans vulnerable to a gap in their medical coverage,” he wrote.

Health and Human Services Secretary Kathleen Sebelius was scheduled to testify before the Senate Finance Committee on Wednesday.