Read all posts from December 2010

  • After the President's remarks on the Afghanistan-Pakistan Annual Review, Defense Secretary Robert Gates, Secretary of State Hillary Clinton, and General James Cartwright, the Vice Chairman of the Joint Chiefs of Staff, stayed on to take questions.  Responding to a question about the New START treaty, General Cartwright made his position quite clear:

    [O]n START, for me, all of the Joint Chiefs are very much behind this treaty, because of the transparency, because of the reality that both the United States and Russia are going to have to recapitalize their nuclear arsenals, both the delivery vehicles and the weapons.  To have transparency, to understand the rules by which to put structure to that activity, we need START and we need it badly.
    I think the last piece of that that oftentimes gets overlooked when you’re thinking about START is that this is a relationship between our countries.  And in the context that Secretary Clinton just put forward, much more than just the nuclear is relying on this treaty.  This is no prohibitions to our ability to move forward in missile defense, which gives us a much better deterrent when combined with the offensive side as we move to the future.  A single mutual assured destruction approach to deterrence is just not relevant as we move into the 21st century.  We need this treaty in order to move in that direction.

    Press play to watch the video beginning with General Cartwright's comments:

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  • Read the Transcript  |  Download Video: mp4 (97MB) | mp3 (9MB)

    As the President took to the podium to discuss the Afghanistan-Pakistan Annual Review released today, he thanked all involved in the effort -- from Defense Secretary Gates of Secretary of State Clinton to Chairman of the Joint Chiefs Admiral Mullen, as well as the late Ambassador Richard Holbrooke.  He saved his most sincere respect for our troops, however, saying, "There are more difficult days ahead.  But as a nation, we can draw strength from the service of our fellow Americans.  On my recent visit to Afghanistan, I visited a medical unit and pinned Purple Hearts on some of our wounded warriors.  I met with a platoon that had just lost six of their teammates.  Despite the tough fight, despite all their sacrifice, they continue to stand up for our security and for our values that we hold so dear."  During their briefing afterwards Secretary Gates and Secrtary Clinton echoed those sentiments.

    From the outset of his discussion of the report, he leveled with the American people: 

    I want to be clear.  This continues to be a very difficult endeavor.  But I can report that thanks to the extraordinary service of our troops and civilians on the ground, we are on track to achieve our goals.

    It’s important to remember why we remain in Afghanistan.  It was Afghanistan where al Qaeda plotted the 9/11 attacks that murdered 3,000 innocent people.  It is the tribal regions along the Afghan-Pakistan border from which terrorists have launched more attacks against our homeland and our allies.  And if an even wider insurgency were to engulf Afghanistan, that would give al Qaeda even more space to plan these attacks. 

    And that’s why, from the start, I’ve been very clear about our core goal.  It’s not to defeat every last threat to the security of Afghanistan, because, ultimately, it is Afghans who must secure their country.  And it’s not nation-building, because it is Afghans who must build their nation.  Rather, we are focused on disrupting, dismantling and defeating al Qaeda in Afghanistan and Pakistan, and preventing its capacity to threaten America and our allies in the future. 

    In pursuit of our core goal we are seeing significant progress.  Today, al Qaeda’s senior leadership in the border region of Afghanistan and Pakistan is under more pressure than at any point since they fled Afghanistan nine years ago.  Senior leaders have been killed.  It’s harder for them to recruit; it’s harder for them to travel; it’s harder for them to train; it’s harder for them to plot and launch attacks.  In short, al Qaeda is hunkered down.  It will take time to ultimately defeat al Qaeda, and it remains a ruthless and resilient enemy bent on attacking our country.  But make no mistake -- we are going to remain relentless in disrupting and dismantling that terrorist organization. 

    In Afghanistan, we remain focused on the three areas of our strategy:  our military effort to break the Taliban’s momentum and train Afghan forces so they can take the lead; our civilian effort to promote effective governance and development; and regional cooperation, especially with Pakistan, because our strategy has to succeed on both sides of the border. 

    Indeed, for the first time in years, we’ve put in place the strategy and the resources that our efforts in Afghanistan demand.  And because we’ve ended our combat mission in Iraq, and brought home nearly 100,000 of our troops from Iraq, we’re in a better position to give our forces in Afghanistan the support and equipment they need to achieve their missions.  And our drawdown in Iraq also means that today there are tens of thousands fewer Americans deployed in harm’s way than when I took office. 

    With those additional forces in Afghanistan, we are making considerable gains toward our military objectives.  The additional military and civilian personnel that I ordered in Afghanistan are now in place, along with additional forces from our coalition, which has grown to 49 nations.  Along with our Afghan partners, we’ve gone on the offensive, targeting the Taliban and its leaders and pushing them out of their strongholds. 

    After discussing each of those areas in more depth, he closed with a simple message:

    We’re going to have to continue to stand up.  We’ll continue to give our brave troops and civilians the strategy and resources they need to succeed.  We will never waver from our goal of disrupting, dismantling, and ultimately defeating al Qaeda.  We will forge enduring partnerships with people who are committed to progress and to peace.  And we will continue to do everything in our power to ensure the security and the safety of the American people.

  • Ever wanted someone to pick out the highlights from what's happening at The White House so you wouldn't have to sift through all the latest news?  Curious about what the White House is reading online?  Are you a fan of Digg?

    Good news everyone.  The White House is now on  Take a peek and start following us right now. 

    And as always, if you like your White House updates and news to come to you, stay connected on:


  • "A Night in December" courtesy of Defense Media Activity’s Emerging Media Directorate, servicemembers at more than 40 commands around the world, and Toby Keith -- learn more about all the commands involved from their blog.

  • Ed. Note: Learn more about the new Office of Indian Energy Policy and Programs being announced from the Department of Energy's blog.

    Download Video: mp4 (143MB) | mp3 (9MB)

    This morning we kicked off the White House Tribal Nations Conference, a gathering that is a testament to President Obama's respect for the inherent sovereignty of Indian nations and determination to honor the Nation's commitments to American Indian and Alaska Native communities.

    President Obama is hosting the conference here at the Department of the Interior - the second he has convened since taking office - and delivered keynote remarks to leaders of the 565 federally recognized tribes in the United States.  Members of the President's cabinet and other high-ranking Administration officials will be participating in a series of breakout sessions with tribal leaders, discussing a wide range of social, economic and political challenges facing Indian Country.   It is rare that so many of us are in one place at the same time and it speaks to President Obama's high-level engagement with and commitment to Indian Country.

    A little over a year ago - at the first-ever White House Tribal Nations Conference - President Obama pledged that we would work with American Indian leaders to fulfill our trust responsibilities, to empower tribal governments and to help build safer, stronger and more prosperous tribal communities.

    While we have made great progress on these fronts, there is much work to be done - by all of us.  It is my hope that today provides a venue through which to continue a candid and honest dialogue between and among nations as we develop a comprehensive agenda to reform, restructure and rebuild federal relations with Indian Country. 

    Together we are building a solid foundation for a bright, prosperous and more fulfilling future for the First Americans.

    A Navajo Code Talker from WWII Listens to President Barack Obama at the Tribal Nations Conference

    A Navajo Code Talker from WWII and others in the audience listen as President Barack Obama delivers remarks during the opening session of the Tribal Nations Conference at the U.S. Department of Interior in Washington, D.C. December 16, 2010. (Official White House Photo by Pete Souza)

  • Today, President Obama signed legislation that will stop a significant pay cut for doctors who treat Medicare patients from taking effect. The pay cut was called for under an old formula called the Sustainable Growth Rate (SGR) that governs how much doctors are paid to treat seniors on Medicare and military families enrolled in the TRICARE program. President Obama and members of both parties agree this formula needs to be changed. Without the action the President took today, doctors who see Medicare patients and families enrolled in TRICARE would have seen their payments slashed by 23 percent.

    The pay cut wouldn't have just hurt doctors – seniors and families across America would have suffered as well. Many doctors would have simply stopped seeing Medicare patients and military families if this pay cut took effect, effectively denying patients the chance to see the doctor they know and trust.

    That wasn't acceptable to President Obama or leaders in Congress and the law the President signed today delays the pay cut from taking effect for another year.

    The law wouldn’t have been possible without volunteers like Brenda Kelley of Woodbridge, Virginia and Robert Sargeant of Fairfax, Virginia. Brenda and Robert were two of the thousands of AARP members who worked hard to make this legislation a reality. They made phone calls, wrote letters, and helped ensure this important legislation was enacted.

    They weren’t alone. American Medical Association President Cecil Wilson and Board Chair Ardis Hoven, along with doctors from across the country spoke out about the importance of ensuring doctors knew how much they would be paid for treating seniors on Medicare. Together with AARP CEO Barry Rand, AARP Board Chair Lee Hammond and Military Officers Association of America President Admiral Norbert Ryan, these individuals who helped protect seniors, military families and doctors celebrated with President Obama as he signed this legislation into law in the Oval Office.

    They were also joined by some of the bipartisan leaders in Congress who helped pass this law including:

    • Senator John Barrasso, R-WY
    • Senator Max Baucus, D-MT
    • Representative Henry Waxman, D-CA

    Today was an important milestone, but signing this law is just the first step. For years, Congress and Presidents from both parties have acted to stop pay cuts for doctors called for by the Sustainable Growth Rate. Each solution was temporary, forcing Congress to continually deal with this matter and leaving doctors to wonder if they would be forced to take a pay cut in the future.

    After years of temporary measures, the President believes it's time for a permanent solution. Over the next year, the President and his team will work with Congress to address this matter once and for all. We all agree that this formula needs to be changed. Now's the time to get it done.

    Nancy-Ann DeParle is the Director of the White House Office of Health Reform

  • The fatal shooting of Border Patrol Agent Brian A. Terry last night is an unconscionable act of violence against the men and women of the Border Patrol and all those who serve and defend our country.

    Agent Terry was killed in the line of duty while confronting several suspects near Rio Rico, Ariz. It is a stark reminder of the very real dangers our men and women on the frontlines confront every day as they protect our communities and the American people.

    We are working with other federal, state and local authorities to ensure those responsible for this horrendous act are held responsible. We will leave no stone unturned as we seek justice for the perpetrators.

    I want to extend my deepest condolences to Agent Terry’s family at this difficult time. We will honor his memory by remaining resolute and committed to the serious task of securing our nation’s borders. I ask that all of us keep Agent Terry and his family in our prayers.

    Janet Napolitano is Secretary of Homeland Security

  • Read the Transcript  |  Download Video: mp4 (44MB) | mp3 (4MB)

    As the President prepared for a meeting this morning with some of America's top CEOs on ways to get the economy moving again, the Senate was preparing to pass the tax cut and unemployment insurance compromise, which they did by a wide bipartisan margin.  The President explained why he hoped the House would do the same:

    I am absolutely convinced that this tax cut plan, while not perfect, will help grow our economy and create jobs in the private sector.  It will help lift up middle-class families, who will no longer need to worry about a New Year’s Day tax hike.  It will offer emergency relief to help tide folks over until they find another job.  And it includes tax cuts to make college more affordable; help parents provide for their children; and help businesses, large and small, expand and hire.

    The President also explained what he was hoping to focus on in the meeting:

  • Ed. Note: This is the fifth in a series of posts from top Administration Officials on the importance of the DREAM Act.  Read Education Secretary Arne Duncan's post here, Labor Secretary Hilda Solis's contribution here, Commerce Secretary Gary Locke's post here, and Homeland Security Secretary Janet Napolitano's here.

    In three decades of service in the Marine Corps, I served with many people who immigrated to our nation looking for a better life.  Regardless of their backgrounds, they had – and still have –  one core mission in life: to serve others.

    There is a rich tradition of non-citizens serving in the United States military since the Revolutionary War.  Their life experiences, languages and cultures enhance diversity, ensuring that our military continues to represent the nation it serves.  The DREAM Act would build on this tradition.

    Thousands of young people graduate from American high schools every year who are DREAM eligible; who have the determination and the qualifications to join the military and serve our nation.  The DREAM Act would provide the military the opportunity to reach out to this pool of qualified youth eligible to join, and strengthen the All Volunteer Force. 

    We have an opportunity to provide citizenship for people who are talented, who would like to bring the benefits they have received to others.  But for circumstances beyond their control, we don't allow them to serve.  To ignore that opportunity – to ignore them – simply is unconscionable.

  • On Monday, President Obama signed the Healthy, Hunger-Free Kids Act into law.  This legislation is an important step forward toward ensuring that no child goes to school hungry and that all children have access to healthy, nutritious foods at school.

    Earlier this week, Elmo visited Assistant White House Chef Sam Kass in the White House kitchen to talk about the importance of healthy and delicious school meals. Check out the video below.

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    First Lady Michelle Obama is passionate about fighting the childhood obesity epidemic, that’s why she started Let’s Move! a nationwide campaign raise a healthier generation of kids.  As part of this effort the First Lady was a vocal advocate for this important legislation.

    Learn more about how the Health, Hunger-Free Kids Act will increase access to healthy, nutritious foods in schools. 

  • On Monday, a Virginia judge issued a narrow ruling on the constitutionality of the individual responsibility provision in the Affordable Care Act. In two other cases – including a separate case in Virginia -- federal judges looked at the merits of the opponents’ arguments and upheld the law. 12 other challenges to the law have been dismissed by courts across the country. You can learn more about these court cases and the Administration’s arguments here.

    In the days following the ruling in Virginia, editorial boards nationwide have examined the decision and the Affordable Care Act’s individual responsibility provision. Here’s what they are saying:

    In that sense, what's at stake isn't Americans' cherished "right to be let alone." It's whether they'll continue to be stuck in a system in which millions of uninsured people force those with insurance to pick up at least part of the tab for their visits to the emergency room and for the untreated diseases that they spread. Two other federal judges have held the law to be constitutional for just that reason. As District Judge George Caram Steeh in Michigan wrote in an October ruling, "Far from 'inactivity,' by choosing to forgo insurance, plaintiffs are making an economic decision to try to pay for healthcare services later, out of pocket, rather than now through the purchase of insurance, collectively shifting billions of dollars — $43 billion in 2008 — onto other market participants."

    …If the courts consider the mandate in its proper context, they'll see that it doesn't violate the Constitution.

    The only reasonable way insurance companies could afford to stop their most noxious practices, such as denying coverage to people with pre-existing conditions or cancelling coverage once someone became seriously ill, was if more Americans shared the risk and insurers got millions of new customers who were required to have coverage.

    If the requirement that most Americans buy insurance is thrown out, but the insurance reforms remain in place, premiums would skyrocket for existing policyholders.

    The individual mandate once enjoyed significant support among conservatives, who saw it as promoting an ethic of personal responsibility, but the drive to oppose President Obama's signature reform led many of them to abandon that principle and denounce the insurance mandate as big government run amok. They had it right in the first place.

    The law certainly has a constitutional basis. Congress has a right to address health care, which accounts for one-sixth of the nation’s economy, and it has a right to regulate an industry that affects everyone.

    The health care system in this country long has been inequitable, benefiting large insurance companies. The new law would make strides toward leveling the playing field, fairly spreading the costs, protecting patients’ rights and driving down premiums. That’s a good deal, yet some conservatives are more interested in protecting the insurance industry over the public, claiming the law violates their liberty. But that’s a disingenuous argument.

    The reality is that by providing more equity in the system, the health care law isn’t undercutting liberty, it’s actually upholding it.

    As a matter of law, Monday’s unsurprising decision by Judge Hudson means the constitutionality question remains unsettled. The final word will come from the U.S. Supreme Court, as has always been expected.

    As a matter of fact, however, the question was settled long ago.

    Judge Hudson is entirely and demonstrably wrong. His grasp of health care economics and the realities of the marketplace are, to put it charitably, flawed. His ruling is an exercise in sophistry…

    …[H]is ruling would be a blow to the vast majority of responsible Americans who already have health insurance. They’ll have to continue footing ever-higher premiums to cover freeloaders who refuse to take responsibility for their own care.

    Yet it seems clear that decisions not to buy insurance will, in the aggregate, affect costs in the broader health care markets. We hope higher courts will find that a decision to forgo insurance simply shifts much of the cost for subsequent illness to hospitals, doctors and insured individuals. Taxpayers’ costs would rise to pay for billions of dollars in uncompensated care given to individuals who can’t pay for it…

    Virginia’s attorney general had asked the judge to invalidate the entire law if he found the mandate to buy insurance unconstitutional, but Judge Hudson invalidated only the mandate. He said he was following a time-honored rule to “sever with circumspection” by removing only problematic parts of a law.

    The attorney general had also asked the judge to stop implementation of the law until a higher court rules on its constitutionality. Judge Hudson sensibly denied that request in part because the crucial provisions of the mandate, the only issue he was addressing, don’t take effect until 2013. Preparatory steps are not irreversible and states should not hang back while this case is being appealed and likely decided by the Supreme Court.

    Importantly - and correctly - Judge Hudson, in invalidating the individual mandate, declined to bring down the rest of the law with it, as Virginia had asked. It is true that the individual mandate is key to making numerous other provisions of the law workable, such as the prohibition against denying insurance coverage or charging more to those with preexisting conditions. But Judge Hudson's approach was properly restrained. On the constitutionality of the individual mandate, he made what we consider the wrong call in a difficult case. But he did it in a thoughtful way that will be minimally disruptive to implementing the law and obtaining a final determination on its constitutionality.

    Stephanie Cutter is Assistant to the President for Special Projects


  • Dr. Jill Biden on Cooking Show

    Natalie and Beau Biden join Dr. Biden and Rachael Ray in preparing a holiday care package for military servicemembers, December 15, 2010. (by David M. Russell)

    The holiday season is a great time to stop and say thanks, especially to those who serve our country.  Dr. Biden called on Americans to thank and support our military service members and their families in any way they can during an appearance on the Rachael Ray Show which airs today.  Dr. Biden shared tips for making care packages for service members serving abroad, as well for families of those who are deployed.  The entire studio audience also joined Dr. Biden and Rachael in writing cards to thank members of the military and veterans for their service.  As she mentioned on the show, there are multiple ways to get involved, so take the time today to think about what you can do to help support this effort. For more information, and to find options in  your community - you can visit

  • Ed. Note: Tour the 2010 Simple Gifts decorations, send “Seasons Greetings” to our troops, watch behind-the-scenes videos and more on our Holidays at the White House page.

    Continuing a tradition dating back to Bess Truman, First Lady Michelle Obama visited the Children’s National Medical Center in Washington, D.C. She met with patients and staff, read The Night Before Christmas to a captive audience and answered some of the children’s most pressing questions, including: Where’s Bo? What did you get Bo for Christmas? And which White House chimney does Santa use?

    FLOTUS & Bo Greet People

    First Lady Michelle Obama greets kids, parents, and caregivers with Bo, the Obama family dog, at the Children's National Medical Center in Washington, D.C., Dec. 13, 2010. (Official White House Photo by Samantha Appleton)

    Watch a video of Mrs. Obama read The Night Before Christmas to children, parents and staff and answer the children's questions:

    Download Video: (229.5MB)

  • Ed. Note: This is the fourth in a series of posts from top Administration Officials on the importance of the DREAM Act.  Read Education Secretary Arne Duncan's post here, Labor Secretary Hilda Solis's contribution here, Commerce Secretary Gary Locke's post here.

    Over the past several weeks, the President and my fellow Cabinet members have talked about a number of important reasons to support the DREAM Act. Today, I’d like to speak to the important role the DREAM Act would have in promoting public safety though smart and effective immigration enforcement.

    By providing a firm, but fair, means for individuals who were brought to the United States as children to adjust their status, the DREAM Act would bolster the Department of Homeland Security’s ability to focus our limited enforcement resources on detaining and removing criminal aliens and those who pose a threat to our national security and public safety. 

  • Ed. Note: Cross-posted from the Energy Blog.

    Check out Google Earth – the ‘view from above’ of your favorite American city. And look at the roofs of the office buildings, warehouses, shopping centers, and even the homes. Most of them are probably pretty dark in color – and this means they heat up a lot when the weather is warm – up to 50 degrees hotter than light roofs. All of those dark roofs mean that as a nation we’re using a lot more air conditioning than we need to. At least a billion dollars a year in extra power bills, in fact. And when you combine hot roofs with dark roads and parking lots, we get the ‘urban heat island’ effect: cities tend to be 2-5 degrees hotter than less urban areas just because of all the dark surfaces.

    But there’s something we can do about it: changing to a ‘cool roof.’ The Department of Energy just did this in our Washington, DC headquarters. It was time to replace our roof anyway, so for no extra cost we went to a ‘cool’ white material. And we’re hoping others follow this lead.

    Here's a video of Secretary Chu giving his thoughts on our new cool roof: 

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  • From the earliest days of the Obama administration, we have been working to promote innovation and competitiveness in high-growth sectors like renewable energy and energy efficiency (RE&EE).  President Obama’s Recovery Act, for instance, made the single largest investment in clean energy in our nation’s history. Over $90 billion was invested through the Recovery Act to promote everything from advanced wind turbines and solar panels to new battery technologies and the modernization of our electricity grid. 

    Thanks to these investments and the ingenuity of U.S. businesses, America is on track to meet the president’s goal of doubling the country’s installed capacity of renewable energy technologies by 2012

    But spurring domestic clean energy innovation to meet America’s needs is only half of the picture.

    Empowering U.S. business to create and deliver those new technologies to energy-hungry foreign markets is the other.

  • This Wednesday, December 15, 2010, the Obama Administration is hosting the first White House Forum on Environmental Justice to build on our commitment to ensuring that overburdened and low-income communities have the opportunity to enjoy the health and economic benefits of a clean environment.  At lunch, U.S. Environmental Protection Agency Administrator Lisa P. Jackson and I will host a live Facebook chat to answer your questions about the Obama Administration’s work to create a healthy and sustainable environment for all Americans.

    EJ Meeting - Nancy, LPJ

    CEQ Chair Nancy Sutley, EPA Administrator Lisa Jackson, Attorney General Eric Holder, and HUD Secretary Shaun Donovan discuss environmental justice issues in September.

    Tune in on Wednesday, December 15th at 12:50PM EST to participate in the discussion live at  To submit your questions on Facebook, sign on to  Also, watch the White House Forum live all day, beginning at 10am, at

    Nancy Sutley is Chair of the White House Council on Environmental Quality

  • Ed. Note: This is the third in a series of posts from top Administration Officials on the importance of the DREAM Act.  Read Education Secretary Arne Duncan's post here and Labor Secretary Hilda Solis's contribution here.

    Every day, hundreds of thousands of Americans get up and go to work at blue chip companies like Pfizer, DuPont, Google, Procter and Gamble and Intel.

    These are very different companies operating in different industries – but they’ve got at least one thing in common.

    All of them were started by immigrants.

    It’s no coincidence.  The constant influx of new cultures, new ideas and new ways of looking at old problems is a big part of the reason why America has been the most dynamic economy in the world for well over a century.   

  • Read the Transcript  |  Download Video: mp4 (192MB) | mp3 (19MB)

    As one of her chief responsibilities and greatest passions, the First lady has dedicated herself to helping our children grow up healthy and reversing the alarming childhood obesity trend -- so the President's signing of the the Healthy, Hunger-Free Kids Act this morning at a local DC school was particularly meaningful for her:

    We can all agree that in the wealthiest nation on Earth, all children should have the basic nutrition they need to learn and grow and to pursue their dreams, because in the end, nothing is more important than the health and well-being of our children.  Nothing.  And our hopes for their future should drive every single decision that we make.

    The President applauded the bipartisan support for this significant legislation, and explained the broader implications for how nutrition affects our kids as they grow up: "we need to make sure our kids have the energy and the capacity to go toe to toe with any of their peers, anywhere in the world.  And we need to make sure that they’re all reaching their potential."  A fact sheet (pdf) issued this morning along with statements of support from across the political spectrum described exactly how the bill acheives these goals, and a sample menu (pdf) shows what it will mean in real life:

    Sample Menu Before & After Child Nutrition Bill

  • Today’s narrow ruling in Virginia on the constitutionality of a provision of the Affordable Care Act is just one of many recent rulings on similar cases that have come down in recent months.  Since the law passed, opponents of reform have filed more than 20 different legal challenges.   Judges have already granted the Administration’s motion to dismiss 12 of these cases.   And in two cases, federal judges looked at the merits of the opponents’ arguments, determined that the Affordable Care Act is constitutional and upheld the law.

    We disagree with the ruling issued today in Virginia and the Department of Justice is considering its appeal options.

    We are pleased that Judge Hudson agrees that implementation of the law will continue uninterrupted.   In the nine months since the health reform law was passed, we’ve made tremendous progress to strengthen our health care system, including lowering costs and implementing a new patient’s bill of rights to end some of the worst insurance company abuses. That work continues. And we’re confident that when it’s all said and done, the courts will find the Affordable Care Act constitutional. 

    History and the facts are on our side.  Similar legal challenges to major new laws -- including the Social Security Act, the Civil Rights Act, and the Voting Rights Act -- were all filed and all failed.  Contrary to what opponents argue the new law falls well within Congress’s power to regulate economic activity under the Commerce Clause, the Necessary and Proper Clause, and the General Welfare Clause.

    Opponents of reform claim that the individual responsibility requirement – the requirement that all Americans carry a minimum level insurance by 2014 –exceeds Congress’ power to regulate interstate commerce because it penalizes economic “inactivity.”   Make no mistake -- individuals who choose to go without health insurance are actively engaged in economic decision making – the decision to pay for health care out-of-pocket or to seek uncompensated care.  Every year millions of those who have chosen to go without health insurance actively seek medical care, which is evident in the billions of dollars spent on uncompensated care every year.

    The Affordable Care Act came into being precisely because of the interconnectedness of our health care costs.   People who make an economic decision to forego health insurance do not opt out of the health care market, but instead shift their costs to others when they become ill or are involved in an accident and cannot pay.  Those costs – $43 billion in 2008 alone – are borne by doctors, hospitals, insured individuals, taxpayers and small businesses throughout the nation.  This cost-shift added on average $1,000 to family premiums in 2009 and roughly $410 to an individual premium.

    This concept is clearly seen in other areas of commerce.  For example, in most states, drivers are required to carry a minimum level of auto insurance. Accidents happen and when they do, they need to be paid for quickly and responsibly. Requiring drivers to carry auto insurance accomplishes this goal. Similarly, the Affordable Care Act, through the individual responsibility requirement, will require everyone to carry some form of health insurance since everyone at some point in time participates in the health care system, and incur costs that must be paid for.

    It’s no surprise then, that President Reagan’s Solicitor General Charles Fried recently wrote, “the health care law’s enemies have no ally in the Constitution.” Two federal judges that recently ruled on the challenge to the constitutionality of the reform law in Michigan and Virginia agreed. These lawsuits were dismissed, with the federal judge in Virginia concluding “how and when to pay for health care are activities…in the aggregate…substantially affect[s] the interstate health care market.”   

    Two federal judges have agreed with this argument. In an earlier ruling in the Western District of Virginia, a federal judge wrote:

    “I hold that there is a rational basis for Congress to conclude that individuals’ decisions about how and when to pay for health care are activities that in the aggregate substantially affect the interstate health care market…Nearly everyone will require health care services at some point in their lifetimes, and it is not always possible to predict when one will be afflicted by illness or injury and require care…Far from ‘inactivity,’ by choosing to forgo insurance, Plaintiffs are making an economic decision to try to pay for health care services later, out of pocket, rather than now, through the purchase of insurance. As Congress found, the total incidence of these economic decisions has a substantial impact on the national market for health care by collectively shifting billions of dollars on to other market participants and driving up the prices of insurance policies.”

    The Affordable Care Act also bans insurance companies from discriminating against people with preexisting conditions.   However, unless every American is required to have insurance, it would be cost prohibitive to cover people with preexisting conditions.  Here’s why:  If insurance companies can no longer deny coverage to anyone who applies for insurance – especially those who have health problems and are potentially more expensive to cover – then there is nothing stopping someone from waiting until they’re sick or injured to apply for coverage since insurance companies can’t say no.  That would lead to double digit premiums increases – up to 20% – for everyone with insurance, and would significantly increase the cost health care spending nationwide.  We don’t let people wait until after they’ve been in a car accident to apply for auto insurance and get reimbursed, and we don’t want to do that with healthcare.  If we’re going to outlaw discrimination based on pre-existing conditions, the only way to keep people from gaming the system and raising costs on everyone else is to ensure that everyone takes responsibility for their own health insurance.   

    There have been many rulings on court cases regarding health reform and we know there will be many more. In the end, the Affordable Care Act will prevail and the American people will enjoy the benefits of reform.

    Stephanie Cutter is Assistant to the President for Special Projects