Obama Outlines Progress of ACA, Steps for the Future of Health Care Reform
In a recent JAMA paper, President Obama reviewed progress made since the implementation of the Affordable Care Act, such as expanding health care coverage and reducing the proportion of uninsured Americans nationwide. Obama also outlined strategies for future policymakers to improve his health care law— including adding a public option.
In order to summarize progress on the ACA to date, Obama presented publicly available data obtained from government agencies and published research. Evidence ranged from 1963 to 2016, in order to capture the scope of changing trends in health care access, costs and usage.
According to the special report, the ACA has made progress towards improving access to care, quality of care and cost of care. Obama stated that since the implementation of the ACA in 2010, the uninsured rate has decreased by 43%, from a rate of 16% to 9.1% in 2015. Obama further noted that there have been improvements in access to care, such as an estimated reduction of 5.5% in the share of nonelderly adults who cannot afford health care. The report also highlighted an estimated 3.4% decrease in the proportion of nonelderly adults reporting poor or fair health, indicating improvements in overall health associated with implementation of the health law.
Obama also laid out a lengthy list of recommendations for future policymakers, including expanding Medicaid programs in the 19 states that have yet to implement them, continued support of CMMI and the law’s ACO program, and support of innovative programs like Precision Medicine, BRAIN initiatives, and the Cancer Moonshot.
Additionally, Obama recommended enhancing competition on the Marketplaces by providing a publicly funded health care option.
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“Congress considered and I supported including a Medicare-like public plan,” Obama wrote. “Public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers. I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited. Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.”
Obama also took the opportunity to criticize the partisan opposition to health care reform and the ACA, stating that, “Any change is difficult, but it is especially difficult in the face of hyperpartisanship. We could have covered more ground more quickly with cooperation rather than obstruction. It is not obvious that this strategy has paid political dividends for Republicans, but it has clearly come at a cost for the country, most notably for the estimated 4 million Americans left uninsured because they live in GOP-led states that have yet to expand Medicaid”
In a related editorial, Jonathan Skinner, PhD, of Dartmouth College and Amitabh Chandra, PhD, of the John F. Kennedy School of Government at Harvard University, questioned some of the claims made by Obama, by addressing the difference between expanding insurance coverage and improving health and savings.
“Counting up the number of individuals with insurance is not enough to assess if the ACA was a success,” They stated. “Perhaps the more important measures are whether the ACA improved health and saved money. For example, the 2008 Oregon Health Insurance Experiment, a randomized trial of Medicaid expansion, found that… although almost everyone reported being able to see a physician, hypertension and diabetes control did not change relative to the control group, overall medical spending increased by $1000 per person annually, and emergency department use increased by 40%.”
However, Skinner and Chandra concluded that the implementation and progress of the ACA have been a success. “President Obama has every reason to be proud of a remarkable achievement,” they said. “The nation is better off with the ACA, despite its shortcomings, than without. But health insurance, health care, and health, although often used interchangeably, are not the same. Even though the ACA has, to this point, not accomplished its goal of making health care more affordable, it is also far more moderate, innovative—and difficult to replace—than its critics claim.” –David Costill
Reference:
Obama, B. United States Health Care Reform. JAMA. [Published online July 11, 2016].
