President Obama's ACA assessment

Obama on ACA Progress and Needed Fixes

The Journal of the American Medical Association (JAMA) recently published President Obama's assessment of the Affordable Care Act's progress—and what needs to be done to improve outcomes.

In a JAMA Special Communication (July 11, 2016), President Obama emphasizes the positive impacts of the Affordable Care Act (ACA), most notably the reduction in the number of uninsured. 

© 2016 American Medical Association

© 2016 American Medical Association

While describing these important changes, the president also stresses the need for fixes, something that is not surprising given the magnitude of the reforms espoused in the ACA.

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.

Fixing the ACA is not a new recommendation. After the June 28, 2012, Supreme Court decision that validated the constitutionality of the ACA's individual mandate, Obama stated, "With today's announcement, it's time for us to move forward—to implement and, where necessary, improve on this law."

He reiterated this message three years later, when the Supreme Court upheld the ability of the federal government to provide subsidies to those who purchased insurance through the federal exchange.

In the JAMA article, President Obama goes beyond this general message to detail the problems he sees—along with potential solutions.  


Premiums continue to rise, and affordability remains a major issue that impacts individuals' ability to purchase insurance. One solution the president recommends is to increase the financial subsidies for those who purchase insurance in the exchanges. In addition, to decrease the number of uninsured, states that have not expanded Medicaid need to do so.

Exchange Marketplace Competition:

The theory was that competition would help keep premiums down, but in some areas there is insufficient competition. The president recommends adding a "public option"--a public insurance plan that would increase competition, especially in areas with limited choice of insurers.

Not included in the JAMA article is the US Justice Department's recent decision to file suit to block two huge health insurance mergers: Aetna with Humana, and Anthem (Blue Cross and Blue Shield) with Cigna. These mergers would dramatically decrease market competition, from five mega-insurers to three. 

Prescription Drug Prices:

President Obama makes three recommendations in response to rapidly rising drug prices: increase transparency regarding manufacturers' actual production and development costs, increase rebates for drugs prescribed to certain Medicare and Medicaid beneficiaries, and give the federal government the authority to negotiate prices for certain high-priced drugs.

While these are all good steps to take, ultimately it is important to change our reliance on our complex and costly private insurance system. Congress may be unwilling to do this, so it is up to the states, using the Affordable Care Act's Waiver for State Innovation provision, to move in this more positive direction.