In a Special Communication (SC) published on July 11, 2016 in The Journal of the American Medical Association, President Obama assessed the progress the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) has made toward improving the U.S. health care system and discussed how Congress can build on that progress by providing larger subsidies for private health insurance and creating a public plan like Medicare to compete with private insurers in some states.
White House officials told the New York Times that President Obama’s purpose in writing the SC was to start a discussion and suggest a direction for elected officials and future policy makers, but that he would not be offering detailed new legislative proposals to carry out his ideas.
ACA successes touted. According to the SC, the ACA has increased health insurance coverage, with the uninsured rate declining by 43 percent, from 16 percent in 2010 to 9.1 percent in 2015, with most of that decline occurring after the ACA’s main coverage provisions took effect in 2014. As a result, the number of uninsured individuals in the U.S. has declined from 49 million in 2010 to 29 million in 2015.
Obama also wrote that the ACA has resulted in better access to care, financial security, and health. For example, the President cited research that has documented improvements in access to care (an estimated 5.5 percent reduction in the share of nonelderly adults unable to afford care), financial security (an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage), and health (an estimated 3.4 percent reduction in the share of nonelderly adults reporting fair or poor health).
Obama further wrote that the ACA has helped transform health care payment systems, with nearly 30 percent of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. According to the President, these and other reforms have slowed the growth in per-enrollee health care spending and improvements in health care quality.
More needs to be done. Despite the progress, Obama believes "too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain uninsured." He made the following points in his SC:
- Many of the ACA reforms are still some years from reaching their maximum effect.
- While the ACA has greatly improved the affordability of health insurance coverage, surveys indicate that many individuals still want coverage but are unable to afford it.
- More can and should be done to enhance competition in the Marketplaces.
- Although the ACA included policies to help address prescription drug costs, like more substantial Medicaid rebates and the creation of a pathway for approval of biosimilar drugs, those costs remain a concern—particularly in light of the 12 percent increase in prescription drug spending that occurred in 2014.
Conclusion. The President professed that passage of the ACA and its implementation taught him some important lessons that he has put into practice in both health care policy and other areas of public policy. They are: (1) any change is difficult, but it is especially difficult in the face of hyperpartisanship; (2) special interests pose a continued obstacle to change; and (3) pragmatism in both legislation and implementation is important.
The President concluded by repeating what he said four years ago when the Supreme Court upheld the ACA: "I am as confident as ever that looking back 20 years from now, the nation will be better off because of having the courage to pass this law and persevere. As this progress with health care reform in the U.S. demonstrates, faith in responsibility, belief in opportunity, and ability to unite around common values are what makes this nation great."
Companies: American Medical Association
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