President Obama signs the Affordable Care Act into law on March 23, 2010. He now admits the law needs fixing, but his suggestions would require more taxpayer funding. (AP File Photo)

(CNSNews.com) - President Barack Obama is "quite proud" that his signature health care law has expanded coverage to 20 million more Americans. But he admits the law could be strengthened, White House spokesman Josh Earnest said on Monday.



"The president does have some ideas for things that we could do to further strengthen Obamacare. The first is to find a way to ensure that every state across the country is expanding Medicaid, consistent with what was envisioned in the law."



Earnest said "too many Republican governors" have blocked Medicaid expansion "just because of political differences" with Obama. But some of those governors point to the anticipated cost of Medicaid expansion.





The law said the federal government would pay the full cost of Medicaid expansion for three years, from 2014 through the end of this year. After that, the states would have to pick up an increasing share of the cost.



As the Associated Press reported last week, the cost of expanding Medicaid to millions more low-income people is increasing faster than expected. In a recent report to Congress, the Centers for Medicare and Medicaid Services said the cost of expansion was $6,366 per person for 2015, about 49 percent higher than previously estimated.



(Democrat Hillary Clinton has promised that if she's elected president, she would work to expand Medicaid in the remaining 19 states that have not done so.)



Nevertheless, Earnest told reporters on Monday that because of Republican governors, "there are hundreds of thousands, if not millions of Americans that could have health insurance right now, today, paid for almost entirely by the federal government, that aren't, just because of the political differences that some Republican governors have with the President of the United States.



"That's petty, it's small-minded, and it's having a consequence for the lives of millions of Americans, and it's rather unfortunate."



Earnest noted that in addition to expanding Medicaid, Obama has "also put forward an idea that was discussed actually in the original legislative debate around the Affordable Care Act, which is implementing a so-called public option, allowing, essentially, a publicly (taxpayer) funded health care plan that would compete with private sector proposals. And that this would have the effect of encouraging more competition in the marketplace and limiting the growth in health care costs. Republicans have been resistant to that, unfortunately.



"So the president has some ideas. The president put these ideas forward. The president is under no illusions that those kinds of reforms to strengthen Obamacare will be initiated while he is still in office, but he's hopeful that maybe under the leadership of a new president and a new Congress that those kinds of reforms will take place."



A reporter asked Earnest about the "skyrocketing costs" for individual Obamacare consumers, many of whom live in states where health insurance rates are escalating by double-digits. Poor people get subsidies, but middle class consumer are getting squeezed.



Minnesota, for example, recently announced that for the seven insurers taking part in the individual market, the 2017 rate increases range from 50 percent to 67 percent. Minnesota Commerce Commissioner Mike Rothman has called those rate increases "both unsustainable and unfair.”



“Middle-class Minnesotans in particular are being crushed by the heavy burden of these costs. There is a clear and urgent need for reform to protect Minnesota consumers who purchase their own health insurance,” Rothman said.



What about Obama's promise that the health care law would drive down costs? a reporter asked Earnest.



Earnest noted that the "vast majority" of people get health insurance through their employers, and rate increases there have been "limited." "So you know, it's about 15 percent of Americans that turn to the marketplaces that you're referring to...But look, the president believes that there is more that can be done. It's important to remember that before the Affordable Care Act went into effect, we saw every year a significant skyrocketing in health care costs, so this is not a new phenomenon.



"And the question is, to what extent has the Affordable Care Act been effective in limiting the growth in their health care costs. And what we have seen is that they have been effective in limiting some of that growth, but there is more that we could do to make it much more effective. And we're going to need some action from Congress in order to get that done."



The Obama White House regularly berates Congress, especially Republicans, but the president rarely bothers to meet with members in person. In mid-September, Obama invited four congressional leaders (McConnell, Ryan, Reid and Pelosi) to the White House to discuss the budget and Ziki funding -- the first time since February that he issued such an invitation to lawmakers.