In medical journal, president defends 'Obamacare,' suggests further reforms

With months left of his presidency, President Obama is pushing for a future life for what he considers to be one of his administration’s biggest accomplishments: healthcare reform.

In a Monday scholarly article the president published in peer-reviewed Journal of the American Medical Association (JAMA), Obama points to the accomplishments of the six-year-old Affordable Care Act (ACA), but suggests that there is room for Congress and the next president to improve the law. 

Specifically, he calls for expanding subsidized health coverage to help cover people who can’t afford insurance in the 19 states that have refused to expand Medicaid. 

Obama also urges action in controlling drug prices, “in light of the 12 percent increase in prescription drug spending that occurred in 2014,” and continues to call for a government-run health plan, often called a “public option,” to be offered alongside private plans in rural areas without enough competition necessary to lower costs.

“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,” wrote Obama in a heavily cited article, the first published in JAMA by a sitting president.

The ACA, reports the president, has lowered the rate of people without insurance by 43 percent, from 16 percent in 2010 to 9.1 percent in 2015, the largest decline in the uninsured rate in the five decades since Medicare and Medicaid were introduced. He also cites evidence that the law has improved access to care for those who can’t afford it, financial security among low-income people who now receive subsidized medical coverage, and general health.

Obama also claims, through an analysis of various government statistics, that the law has helped control health care spending, a controversial point that is contested in some of the four editorials that accompany the president’s analysis.

"We don't see evidence that it's doing it," Jonathan Skinner, an economist at Dartmouth College who co-wrote one of the editorials with Amitabh Chandra, a professor of social policy at Harvard University, told The Washington Post.

While the growth in health care spending slowed from 2010 to 2014, costs have recently begun to rise, reports the Post.

However, the president contends that a public option could help lower costs overall. "Public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers," he writes. "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."

The public option concept was popular among liberals during initial health care reform negotiations, but had to be scrapped in order to secure enough votes from moderate Democrats to pass the 2010 bill, as the Associated Press points out.

Hillary Clinton supports a public option in all states, while Donald Trump has said he would end "Obamacare" and replace it with something better, though he hasn’t offered details on what that would be, as the AP reports. Republicans have tried to repeal the ACA, which has survived legal attacks to be upheld by the US Supreme Court.

The goal of Obama’s article in JAMA, according to Kristie Canegallo, a deputy White House chief of staff was to "point future policy makers in the right direction" on health care, reports Bloomberg.

Senior editors at the journal reviewed the article and critiqued its factual claims in a process that took two months, according to the journal’s editor-in-chief Howard Bauchner.

"While we of course recognized the author is the president of the United States, JAMA has enormously high standards and we certainly expected the president to meet those standards," Mr. Bauchner told Bloomberg.