President Barack Obama has some advice for Congress and his successor about where to take health care in America. And at least one recommendation surely will raise Republican hackles: a renewed call for a public health insurance option.
In a Journal of the American Medical Association article published Monday, the originator of the 2010 health care law lays out a lengthy defense of the Affordable Care Act. “Americans can now count on access to health coverage throughout their lives, and the federal government has an array of tools to bring the rise of health care costs under control,” Obama wrote.
A delay in publishing the article prompted by the attack on police officers in Dallas means the president's renewed public option pitch comes a few days after Hillary Clinton, the presumptive Democratic presidential nominee, endorsed it on Saturday.
But House Speaker Paul D. Ryan of Wisconsin, in a statement to Roll Call, took a different stance.
“Obamacare ’s top-down approach has resulted in higher premiums, longer wait times, and fewer options. No matter how the administration spins it, the quality of care for Americans has been diminished because of this law,” Ryan said. “That’s why Republicans are offering a better way, which will replace Obamacare with a patient-first system focused on quality of care.”
But Obama also panned congressional Republicans for “hyperpartisanship” which he claims has kept the law from having a greater effect.
“Through inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation, Republicans undermined ACA implementation efforts,” Obama wrote. “We could have covered more ground more quickly with cooperation rather than obstruction.”
The president and his top aides seem to be relishing every opportunity to take swipes at Republicans on Capitol Hill in the final months of his tenure. But the AMA journal article also previews how the president may emerge as a forceful voice of the left on top issues after he leaves office; many Democrats were reluctant to embrace a government-run insurance plan, or public option, fearing it could lead to excessive federal influence over health markets.
In the journal article, Obama contends that GOP members’ anti-health care law tactics have “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.”
The Republican-controlled Congress has held some 60 votes to repeal or otherwise dismember the law , and Ryan recently rolled out a GOP alternative, though it’s unlikely to get a vote this year.
Conservative groups such as the Heritage Foundation and its political arm, Heritage Action, have harshly criticized the health care legislation even before it ever hit the House or Senate floor.
Last month, Michael Needham , Heritage Action CEO, said “a better health care system requires the repeal of Obamacare,” adding that Ryan’s proposal would install “a number of patient-centered reforms to the employer and individual market, as well as a fundamental rethinking of the health entitlement programs — Medicare and Medicaid — that are driving our country deeper into debt and failing seniors and low income Americans.”
Though Obama wrote in a wonky medical journal, he didn't limit his elbow-throwing to Republicans. He chastised a few players in the health delivery system and lamented the influence of money in politics.
While crafting the law, “we worked successfully with some health care organizations and groups, such as major hospital associations, to redirect excessive Medicare payments to federal subsidies for the uninsured,” Obama wrote. “Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits. We need to continue to tackle special interest dollars in politics.”
The article acknowledges two mistakes his administration made while putting in place the biggest health system overhaul since the 1960s, including the initial failure of HealthCare.gov , the web portal to help people shop for insurance coverage. White House officials who briefed reporters on the article Thursday afternoon could not point to any other mistakes the president believes his administration has made on the law. Kristie Canegallo , White House deputy chief of staff for implementation, said the article stemmed from a six-month assessment of the law’s effects.
“The Affordable Care Act has made significant progress toward solving long-standing challenges facing the U.S. health care system related to access, affordability, and quality of care,” Obama wrote.
He noted a 43 percent drop in the rate of uninsured Americans between 2010, when Obama signed the legislation into law, and 2015. He credits the law with improving access to care and for improving the health of nonelderly adults.
“These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality,” Obama wrote. “Despite this progress, major opportunities to improve the health care system remain.”
The president offered up a roadmap that he said the next Congress and president should follow after he leaves office.
The first part of Obama’s prescribed blueprint is, as Canegallo summarized, to “stay the course” by keeping alive the law’s insurance marketplaces and continuing to “utilize delivery system reform tools.” Another part of the president’s plan is to provide greater federal assistance to those who remain uninsured largely because they still think coverage is too pricey.
But the most controversial aspect of the article is the president’s new pitch for a so-called “public option” similar to Medicare that would be accessible to anyone regardless of age or income.
The option had wide support in public opinion polls but was jettisoned by the administration and its proxies during the fierce congressional health care debate over concerns about excessive government involvement in health markets.
“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,” the president advised. “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.”
House Majority Whip Steve Scalise of Louisiana, however, recently said that it was “time for a better way.”
“We have seen with health care, over 5 million Americans have lost the good health care that they have and liked,” Scalise said. “The president promised if you like what you have, you can keep it. Again, probably one of the most broken promises in political history.”