NASHVILLE — If last week was Barack Obama’s best week as president, Wednesday felt a bit like a victory lap.
In the morning, the president celebrated a final agreement with Cuba to reopen the long-shuttered U.S. embassy in Havana. A few hours later, he spoke and took questions in an elementary school cafeteria in suburban Nashville in front of a crowd of doctors, nurses and area residents who had written letters to him about health care.
The town hall meeting on health care came one week after the Supreme Court shot down a major challenge to the massive government program that would have denied health-care subsidies to millions of Americans participating in the program through a federal marketplace. News of the decision prompted hugs in the Oval Office.
In Nashville, Obama touted the 166,000 Tennesseans — and 16 million people across the country — who have health care because of the Affordable Care Act. Health-care inflation has been trending down, the president said.
“I am feeling pretty good about how health care is going,” he said.
Although it has survived two Supreme Court challenges, the Affordable Care Act is likely to remain a major issue in next year’s presidential election, with virtually all of the Republican candidates decrying it as too costly and vowing, if elected, to dismantle it.
Obama largely dismissed Republican critics and instead spoke about the need to encourage more preventive care, train more health-care professionals and extend coverage to those still uninsured. “The areas where we can still make the biggest difference is to really think more about the delivery system of health care,” Obama said. “Right now we spend too much money on the wrong things and not enough money on the right things.”
He asked, “Are there more ways we can encourage people to get preventive care so that they don’t get sick in the first place, so that we have an actual health-care system instead of a disease-care system?”
The event, which had a relaxed, even down-home feel, wasn’t intended to tout new policy initiatives as much as to celebrate the administration’s recent gains. On the way to Taylor Stratton Elementary School, Obama picked up Kelly Bryant to take her to the meeting. Bryant, a 38-year-old breast cancer survivor, had written to Obama early this year.
“I am still in treatment and will be for a few months,” she wrote in January. “Because of health-care reform, I am not scared of losing everything. I can start thinking about my new life and how the path is paved with opportunities instead of despair.”
Six months later, she met the president at the door of her one-story brick home. On a rainy day, the two walked together under the president’s black umbrella. “I never in my wildest dreams imagined anyone reading it, let alone him,” Bryant said of her letter.
The president also flew to Nashville with Natoma Canfield, a cancer survivor whose 2009 letter urging him to press for health-care reform hangs just outside the Oval Office.
“I would always refer back to her letter when things got a little bleak,” Obama said of Canfield’s letter.
One area in which the White House would like to make more progress is in Medicaid expansion. The federal government is spending billions to cover the costs of the program to expand insurance to low-income Americans, but Republican leaders in some states have balked at accepting the money, saying that they worry that states will eventually have to pick up a larger and larger part of the tab.
In Tennessee, Gov. Bill Haslam (R) has been an advocate of expanding the program but has been unable to convince the Republican-dominated state legislature to accept the federal money. The state is one of 22 not participating in the program, which, if fully implemented, would cover an additional 4.3 million Americans.
“There’s something that can be done, but it’s got to be at the state level,” Obama said when asked about the need to expand health-care coverage further. “It is unfortunate that getting this thing done got so political. . . . There’s still too many people who haven’t signed up or can’t sign up” for health insurance.
A former schoolteacher spoke of the pressure on children mired in poverty, unable to afford health care and frequently hungry. Obama described the difficulty of convincing a cash-strapped middle class to pay more in taxes to help the poor.
“One of the most challenging things as president for me is to try to get folks to recognize that investments in people oftentimes save us money over the long term,” he said. “We make this mistake over and over again.”
The meeting’s overall tone, however, was mostly light, focused as much on the progress made as the problems still ahead. When Obama got a question from a man named Davy Crockett, the president sang a few words from the theme song of the old TV show about the legendary Tennessean.
“Do you remember that television show?” he asked.