President Barack Obama can add a new "first" to his résumé. He's the first sitting president to become an author published in the most prestigious Journal of the American Medical Association. Writing for JAMA, the president outlines the accomplishments of Obamacare, and calls for more reform. He endorses an idea once more gaining steam with the support of Hillary Clinton: a public option in Obamacare exchanges.
I am proud of the policy changes in the ACA and the progress that has been made toward a more affordable, high-quality, and accessible health care system. Despite this progress, 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. More work to reform the health care system is necessary, with some suggestions offered below.
Those suggestions include "further adjustments and recalibrations" to "the law's coverage provisions"; "congressional action to increase financial assistance to purchase coverage, which would also help middle-class families who have coverage but still struggle with premiums"; "enhanc[ing] competition in the Marketplaces"; and prescription drug reforms. That "enhancing competition" bit is the one with the biggest political implications:
The public plan did not make it into the final legislation. Now, based on experience with the ACA, 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.
And speaking of political:
While historians will draw their own conclusions about the broader implications of the ACA, I have my own. These lessons learned are not just for posterity: I have put them into practice in both health care policy and other areas of public policy throughout my presidency.
The first lesson is that any change is difficult, but it is especially difficult in the face of hyperpartisanship. Republicans reversed course and rejected their own ideas once they appeared in the text of a bill that I supported. For example, they supported a fully funded risk-corridor program and a public plan fallback in the Medicare drug benefit in 2003 but opposed them in the ACA. They supported the individual mandate in Massachusetts in 2006 but opposed it in the ACA. They supported the employer mandate in California in 2007 but opposed it in the ACA—and then opposed the administration’s decision to delay it. Moreover, through inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation, Republicans undermined ACA implementation efforts. 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.
He concludes: "I will repeat what I said 4 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." With further reforms, absolutely. But further reforms will only come with a Republican party that regains its sanity and grows a concern for the American public at large. Twenty years might not be a long enough time for that to happen.